Park Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8288 Issued in SC

Legal business name

PARK DENTAL GROUP, LLC

Practice address

1578 Constitution Blvd
Ste 01
Rock Hill, SC 29732-3543

Phone

(803) 366-1456

Fax

(803) 324-0117

NPI assigned

Dec 7, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jae Sung Park

Title

President

Phone

(803) 366-1456

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palmetto Dental Doing business as

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

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1275908923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1578 CONSTITUTION BLVD",
            "address_2": "STE 01",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323543",
            "telephone_number": "803-366-1456",
            "fax_number": "803-324-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1578 CONSTITUTION BLVD",
            "address_2": "STE 01",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323543",
            "telephone_number": "803-366-1456",
            "fax_number": "803-324-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2015-12-07",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JAE SUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-366-1456",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "8288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX8288",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmetto Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtney Marie Palmiere, AUD
• Panoptic Health LLC
• Caroline Pappas, APRN
• Paramount Physical Therapy Services
• Ishika Parekh
• Jae Sung Park, D.M.D.
• Richard In Park, M.D.
• Caroline Parker
• Jessica Parker
• Tarryn Parker

• General Practice Dentistry in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; 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.