Susan N. Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN12538 Issued in FL

Practice address

1661 Estero Blvd
Suite 29
Fort Myers Beach, FL 33931-2846

Phone

(239) 463-5433

Fax

(239) 463-0114

NPI assigned

Jan 14, 2007

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093866477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 ESTERO BLVD",
            "address_2": "SUITE 29",
            "city": "FORT MYERS BEACH",
            "state": "FL",
            "postal_code": "339312846",
            "telephone_number": "239-463-5433",
            "fax_number": "239-463-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 ESTERO BLVD",
            "address_2": "SUITE 29",
            "city": "FORT MYERS BEACH",
            "state": "FL",
            "postal_code": "339312846",
            "telephone_number": "239-463-5433",
            "fax_number": "239-463-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SUSAN",
        "middle_name": "N.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN12538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margarita Nemirovsky, PHARMD
• Illya Y. Novikov, DOCTOR OF DENTISTRY
• Doris Oropesa Carrillo
• Carla Jeannette Osigian Probst, M.D.
• Gregory Palmer, DPT
• Syed MD Parvez
• Robert Pascuzzi, LMT
• Julio Pou Medina
• Preiss Chiropractic & Acupuncture Center II, Inc.
• David Craig Preiss, D.C.

• General Practice Dentistry in Fort Myers Beach, FL
• Providers in Fort Myers Beach, FL by specialty
• General Practice Dentistry in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.