Eastlake Oh Dentist LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

EASTLAKE OH DENTIST LLC

Practice address

34051 Vine St
Eastlake, OH 44095-5107

Phone

(651) 444-9644

NPI assigned

Aug 5, 2026

Organization subpart

No

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

Authorized official

Name

Dr. David Park, DMD

Title

President/Ceo

Phone

(443) 759-0910

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1785888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785888000000",
    "number": "1124942008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34051 VINE ST",
            "city": "EASTLAKE",
            "state": "OH",
            "postal_code": "440955107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34051 VINE ST",
            "city": "EASTLAKE",
            "state": "OH",
            "postal_code": "440955107",
            "telephone_number": "651-444-9644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAKE OH DENTIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-05",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "443-759-0910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelley Divelbiss, LPN
• Cari Dorchock
• Michelle Lee Dorsey
• Christopher Drew
• DRS. Gross, Malcmacher, Thaler & Associates, LLC
• Jacquelyn Fedor
• Lauren K Ferenac
• Shah Huzaifa Feroz, M.D.
• Zoe Sara Fletcher
• Mark S Florman, DDS

• Dental Clinic/Center in Eastlake, OH
• Providers in Eastlake, OH by specialty
• Dental Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; 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.