Individual
DR. LAWRENCE EUGENE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10010 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1626
(260) 490-4440
(260) 490-4448
Mailing address
1517 GREY BIRCH RD, FORT WAYNE, IN 46814-9521
(260) 625-3902
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010099B
IN
Other
Enumeration date
10/25/2006
Last updated
07/08/2007
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