Provider Demographics
NPI:1104971704
Name:PARK, JAMES M (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CHINO AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709
Mailing Address - Country:US
Mailing Address - Phone:909-464-2682
Mailing Address - Fax:909-548-4164
Practice Address - Street 1:3110 CHINO AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709
Practice Address - Country:US
Practice Address - Phone:909-464-2682
Practice Address - Fax:909-548-4164
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice