D Park MPH DDS Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

D PARK MPH DDS DENTAL CORPORATION

Practice address

7743 West LN Ste C5
Stockton, CA 95210-3381

Phone

(209) 474-1101

NPI assigned

Aug 6, 2016

Organization subpart

Yes

Parent organization

D PARK MPH DDS DENTAL CORPORATIONAs reported in NPPES

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

Authorized official

Name

Mr. David Sangho Park, DDS, MPH

Title

Ceo, Cfo

Phone

(310) 403-1117

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Dental Group Doing business as

Tax ID family

D Park MPH DDS Dental Corporation2 organizations share this tax ID, including this one

Part of

D Park MPH DDS Dental Corporation

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• D Park MPH DDS Dental Corporation

  • General Practice Dentistry
  • Tracy, CA
  • NPI 1609450006
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyler Anthony Beninati, DMD

  • Pediatric Dentistry
  • Antioch, CA
  • NPI 1770040412
  NPD (past)
• Mezgan Ramyar, DMD

  • Dentist
  • Tracy, CA
  • NPI 1548438393

  General Practice

  NPD (past)
• Laurent Vien, D.D.S.

  • General Practice Dentistry
  • Stockton, CA
  • NPI 1932114766
  NPD (past)

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1124572284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7743 WEST LN STE C5",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103381",
            "telephone_number": "209-474-1101",
            "fax_number": "209-474-9734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7743 WEST LN STE C5",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103381",
            "telephone_number": "209-474-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D PARK MPH DDS DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "D PARK MPH DDS DENTAL CORPORATION",
        "enumeration_date": "2016-08-06",
        "last_updated": "2022-01-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "SANGHO",
        "authorized_official_title_or_position": "CEO, CFO",
        "authorized_official_telephone_number": "310-403-1117",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS, MPH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53724",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CV Physical Therapy, Inc
• CV Physical Therapy, Inc.
• Markie Danielle Cwik
• Adrienne Ruth Cyril Kurupp, MBBS
• D Danz & Sons Inc
• Philip M. Da Visio, PA
• Kelly Renee Dabell
• Robert M Dacanay, PHARM D.
• Mariele Dapo Dacoron
• Lacey Dacus

• General Practice Dentistry in Stockton, CA
• Providers in Stockton, 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 Jan 11, 2022; 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.