Individual
DR. JINTAE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6795 S VIRGINIA ST, E, RENO, NV 89511-1171
(775) 853-0503
(775) 853-0504
Mailing address
815 KILEY RANCH PKWY, 2901, SPARKS, NV 89436-4066
(626) 434-6150
(775) 657-8619
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
54686
CA
122300000X
Dentist
Primary
5678
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D54686
—
CA
Enumeration date
02/13/2007
Last updated
01/09/2010
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