Provider Demographics
NPI:1285798306
Name:PARK, STANLEY J (DDS)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:J
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 1:10025 GOVERNOR WARFIELD PKWY STE 218
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3340
Mailing Address - Country:US
Mailing Address - Phone:410-997-8383
Mailing Address - Fax:410-997-8434
Practice Address - Street 1:10025 GOVERNOR WARFIELD PKWY STE 218
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3340
Practice Address - Country:US
Practice Address - Phone:410-997-8383
Practice Address - Fax:410-997-8434
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice