Provider Demographics
NPI:1730181454
Name:PARK, JOHN J (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
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 1:1079 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3706
Mailing Address - Country:US
Mailing Address - Phone:541-344-7900
Mailing Address - Fax:877-700-4985
Practice Address - Street 1:1079 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3706
Practice Address - Country:US
Practice Address - Phone:541-344-7900
Practice Address - Fax:877-700-4985
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD72951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice