Heather Hana Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

104291 Issued in CA

Practice address

78595 Highway 111 Ste 300
La Quinta, CA 92253-2084

Phone

(760) 771-0300

NPI assigned

Aug 16, 2019

Last updated

Aug 16, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mowrey Dental Corporation

  dba La Quinta Dental Group

  • General Practice Dentistry
  • La Quinta, CA
  • NPI 1851485635
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1053967794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43100 PALM ROYALE DR APT 426",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922537995",
            "telephone_number": "909-438-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78595 HIGHWAY 111 STE 300",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922532084",
            "telephone_number": "760-771-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "HEATHER",
        "middle_name": "HANA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oto Optometry Management, Inc. (Old Town Optix Optometry, Inc.)
• Pacific Medical Associates, Inc. (Desert Valley Primary Care Associates)
• Frances Palmer, OTR/L
• Angel A Paredes
• Anthony S. Parise
• Sarah Jane Parker
• Barry Lynn Parkins, D.D.S.
• Puri Lorena Arellano Pascual, M.D.
• Taylor Christine Pate
• Junelle Pearson, RN

• General Practice Dentistry in La Quinta, CA
• Providers in La Quinta, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.