Organization
DR D S PARK DENTAL INC
Active
Parent organization
DR D S PARK DENTAL INC
Other names
Smile Dental of Wasco
Organization subpart
Yes
Provider details
NPI number
Legal business name
DR D S PARK DENTAL INC
Authorized official
DR. DAVID S PARK DDS (OWNER)
(310) 403-1117
Entity
Organization
Contact information
Practice address
1245 7TH ST, WASCO, CA 93280-1820
(661) 758-3021
(661) 758-6780
Mailing address
1245 7TH ST, WASCO, CA 93280-1820
(661) 758-3021
(661) 758-6780
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53724
—
CA
Enumeration date
10/24/2019
Last updated
12/04/2020
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