Basic Information
| Provider Information | |||||||||
| NPI: | 1174156004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JULIA J PARK DDS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26547 HUMMINGBIRD CT | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923546750 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 470 ORANGE ST | ||||||||
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| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923743240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097934585 | ||||||||
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| ProviderEnumerationDate: | 02/19/2020 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | PARK | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9092054194 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.