Organization
CLEAN DENTAL OF MESQUITE, P.C.
Active
Other names
Clean Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SANG WOO PARK DDS (CEO)
(614) 530-1189
Entity
Organization
Contact information
Practice address
4402 GUS THOMASSON RD, SUITE A, MESQUITE, TX 75150-2232
(214) 765-6212
Mailing address
4402 GUS THOMASSON RD, SUITE A, MESQUITE, TX 75150-2232
(214) 765-6212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
23653
TX
Other
Enumeration date
01/23/2011
Last updated
12/27/2014
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