Provider Demographics
NPI:1104427418
Name:PAK, JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:PAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 KNIGHTSBRIDGE RD.
Mailing Address - Street 2:APT 6212
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:404-647-9049
Mailing Address - Fax:
Practice Address - Street 1:3167 PEACHTREE RD NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1812
Practice Address - Country:US
Practice Address - Phone:404-647-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367861223G0001X
GADN122728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice