Individual
PETER PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
246 W COLLEGE ST, COVINA, CA 91723-1910
(626) 966-2222
Mailing address
26061 LAWTON AVE, LOMA LINDA, CA 92354-3836
(423) 322-7394
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
64710
CA
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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