Provider Demographics
NPI:1023148749
Name:PARK, STEVE Y (DDS,PLLC)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:Y
Last Name:PARK
Suffix:
Gender:M
Credentials:DDS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 3RD AVENUE #200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-554-7755
Mailing Address - Fax:206-554-7754
Practice Address - Street 1:810 3RD AVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-554-7755
Practice Address - Fax:206-554-7754
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA104101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice