Active NPI
Dong S Park, DDS
- Periodontics
- Chantilly, VA
National Provider Identifier
1013963230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401414636
- Practice address
- 14100 Park Meadow Dr Ste 110
Chantilly, VA 20151-2292 - Phone
- (703) 466-5115
- Fax
- (703) 466-5502
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401414636 | VA | Primary |
Addresses
Primary practice location
14100 Park Meadow Dr Ste 110
Chantilly, VA 20151-2292
Mailing address
14100 Park Meadow Dr Ste 110
Chantilly, VA 20151-2292
Phone (703) 466-5115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401414636 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679270400000",
"number": "1013963230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14100 PARK MEADOW DR STE 110",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201512292",
"telephone_number": "703-466-5115",
"fax_number": "703-466-5502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14100 PARK MEADOW DR STE 110",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201512292",
"telephone_number": "703-466-5115",
"fax_number": "703-466-5502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "DONG",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2023-03-20",
"certification_date": "2023-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401414636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.