Puyallup Park Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60048922 Issued in WA

Legal business name

PUYALLUP PARK DENTAL

Practice address

13909 Meridian E Ste A1
Puyallup, WA 98373-9180

Phone

(253) 435-0333

Fax

(253) 435-0362

NPI assigned

Apr 17, 2018

Organization subpart

No

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

Authorized official

Name

Byungjun Park, DDS

Title

Owner

Phone

(253) 435-0333

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1164919981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13909 MERIDIAN E STE A1",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983739180",
            "telephone_number": "253-435-0333",
            "fax_number": "253-435-0362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13909 MERIDIAN E STE A1",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983739180",
            "telephone_number": "253-435-0333",
            "fax_number": "253-435-0362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP PARK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "BYUNGJUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-435-0333",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60048922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Puyallup Dental, LLC
• Puyallup Dermatology Clinic Inc P.S.
• Puyallup Endocrine & Nuclear Medicine Clinics
• Puyallup Imaging Consultants LLC
• Puyallup Open Imaging LLC
• Puyallup Pediatric Dentistry
• Puyallup Psychotherapeutic Alliance
• Puyallup Radiological Assocs, Inc.
• Puyallup Regenerative Medicine, PLLC
• Puyallup School District

• General Practice Dentistry in Puyallup, WA
• Providers in Puyallup, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.