| Ethan Park Dmd Inc | |
|
5728 Rosemead Blvd Suite 220 Temple City CA 91780-1814 | |
| (626) 500-4340 | |
| (626) 544-5335 |
| Full Name | Ethan Park Dmd Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5728 Rosemead Blvd Suite 220, Temple City, California |
| Authorized Official Name and Position | Ethan Sb Park (OWNER DENTIST) |
| Authorized Official Contact | 2132204856 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethan Park Dmd Inc 5728 Rosemead Blvd Unit 220 Temple City CA 91780-1814 Ph: (626) 544-5335 | Ethan Park Dmd Inc 5728 Rosemead Blvd Suite 220 Temple City CA 91780-1814 Ph: (626) 500-4340 |
| NPI Number | 1275117491 |
|---|---|
| Provider Enumeration Date | 05/12/2021 |
| Last Update Date | 07/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275117491 | NPI | - | NPPES |
| 100873 | Other | CA | DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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