Active NPI
Elizabeth Park, DDS
- Dentist
- Carson City, NV
National Provider Identifier
1003999889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4703
- Practice address
- 501 S Division St
Carson City, NV 89703 - Phone
- (775) 882-1195
- Fax
- (775) 882-3037
- NPI assigned
- Oct 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4703 | NV | Primary |
| Dentist | 122300000X | 52098 | CA |
Addresses
Primary practice location
501 S Division St
Carson City, NV 89703
Mailing address
290 Allerman LN
Gardnerville, NY 89460
Phone (775) 782-8034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 12, 2023 through Dec 12, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52098 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Dental Management Company | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Carson City, NV
- NPI 1710315668
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003999889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "290 ALLERMAN LN",
"city": "GARDNERVILLE",
"state": "NY",
"postal_code": "89460",
"telephone_number": "775-782-8034",
"fax_number": "775-882-3037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S DIVISION ST",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "89703",
"telephone_number": "775-882-1195",
"fax_number": "775-882-3037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ELIZABETH",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "4703",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "52098",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson City, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.