Individual
DR. BRIAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
325 MEETING HOUSE LN, BLDG #2 SUITE 401, SOUTHAMPTON, NY 11968-5087
(631) 283-0352
Mailing address
31 MARTIN PL, SYOSSET, NY 11791-6712
(718) 926-5398
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
051949
NY
Other
Enumeration date
02/14/2008
Last updated
06/03/2009
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