Provider Demographics
NPI:1699504563
Name:PARK, YEON HEE (DMD)
Entity type:Individual
Prefix:DR
First Name:YEON HEE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 COLLEGE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-6277
Mailing Address - Country:US
Mailing Address - Phone:032-557-4151
Mailing Address - Fax:
Practice Address - Street 1:5107 COLLEGE AVE STE 2
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6277
Practice Address - Country:US
Practice Address - Phone:325-574-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist