| John J Park Llc | |
|
2100 Ne Broadway St Portland OR 97232 | |
| (503) 284-2893 | |
| (503) 287-2016 |
| Full Name | John J Park Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2100 Ne Broadway St, Portland, Oregon |
| Authorized Official Name and Position | John Joontae Park (DENTIST, OWNER) |
| Authorized Official Contact | 5033483207 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John J Park Llc 12421 Se Voyageurs Lp Happy Valley OR 97086 Ph: (503) 348-3207 | John J Park Llc 2100 Ne Broadway St Portland OR 97232 Ph: (503) 284-2893 |
| NPI Number | 1992584288 |
|---|---|
| Provider Enumeration Date | 09/26/2023 |
| Last Update Date | 09/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992584288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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