Organization
DR PARK DENTAL CORPORATION
Active
Other names
West AV Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID PARK DDS (CEO)
(310) 403-1117
Entity
Organization
Contact information
Practice address
38745 TIERRA SUBIDA AVE STE 150, PALMDALE, CA 93551-4567
(661) 272-9091
Mailing address
1669 W AVENUE J STE 305, LANCASTER, CA 93534-2870
(661) 802-7544
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
53724
CA
Other
Enumeration date
08/03/2018
Last updated
08/03/2018
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