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6163 Mack Rd Sacramento CA 95823-4654 | |
| (888) 585-3368 | |
| (661) 471-2121 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6163 Mack Rd, Sacramento, California |
| Authorized Official Name and Position | David S Park (DENTIST/OWNER) |
| Authorized Official Contact | 3104031117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6163 Mack Rd Sacramento CA 95823-4654 Ph: (888) 585-3368 | 6163 Mack Rd Sacramento CA 95823-4654 Ph: (888) 585-3368 |
| NPI Number | 1104422245 |
|---|---|
| Provider Enumeration Date | 12/04/2020 |
| Last Update Date | 12/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104422245 | NPI | - | NPPES |
| 53724 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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