Individual
MICHELLE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11124 MIDLOTHIAN TPKE, NORTH CHESTERFIELD, VA 23235-4712
(804) 893-5079
Mailing address
701 N 1ST ST APT 204, RICHMOND, VA 23219-1341
(703) 953-0428
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418988
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2024
Last updated
06/05/2024
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