Organization
GH PARK DDS A DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENE PARK DDS (PRESIDENT)
(310) 780-1296
Entity
Organization
Contact information
Practice address
1031 ROSECRANS AVE STE 104, FULLERTON, CA 92833-1946
(714) 530-1948
(714) 530-1186
Mailing address
1031 ROSECRANS AVE STE 104, FULLERTON, CA 92833-1946
(714) 530-1948
(310) 530-1186
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
49631
CA
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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