| David Park Mph Dds Professional Corporation | |
|
1669 W Avenue J 305 Lancaster CA 93534-2866 | |
| (661) 802-7544 | |
| Not Available |
| Full Name | David Park Mph Dds Professional Corporation |
|---|---|
| Speciality | Dentist |
| Location | 1669 W Avenue J, Lancaster, California |
| Authorized Official Name and Position | David S Park (OWNER) |
| Authorized Official Contact | 6618027455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| David Park Mph Dds Professional Corporation 1669 W Avenue J 305 Lancaster CA 93534-2866 Ph: (661) 802-7544 | David Park Mph Dds Professional Corporation 1669 W Avenue J 305 Lancaster CA 93534-2866 Ph: (661) 802-7544 |
| NPI Number | 1548701626 |
|---|---|
| Provider Enumeration Date | 03/09/2017 |
| Last Update Date | 03/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548701626 | NPI | - | NPPES |
| 53724 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (California) | Primary |
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