Provider Demographics
NPI:1902879430
Name:STEPHEN PARK, D.D.S.
Entity Type:Organization
Organization Name:STEPHEN PARK, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-587-2800
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:#928
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-587-2800
Mailing Address - Fax:
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:#928
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-587-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD81651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty