John I Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN14475 Issued in FL

Practice address

400 Avenue K SE
Ste 12
Winter Haven, FL 33880-4145

Phone

(863) 293-0023

NPI assigned

Jul 19, 2006

Last updated

Jan 6, 2017By the provider in NPPES

Sex

Male

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)

Enrolled

State licenses

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1295754018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVENUE K SE",
            "address_2": "STE 12",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "33880",
            "telephone_number": "863-293-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVENUE K SE",
            "address_2": "STE 12",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338804145",
            "telephone_number": "863-293-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JOHN",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paragon Emergency Services LLC
• Andrew Werner Parish, LMHC
• Lili A Parish, LMHC
• Ilmoon Park, DMD
• Joey Sun Park, CRNA
• William Curtis Parker, DDS
• Jennifer Barbara Parkes, APRN
• Daniel Dean Parks, P.T.
• Julie Anne Parks, APRN, CNM
• Crystal Lee Parrish

• General Practice Dentistry in Winter Haven, FL
• Providers in Winter Haven, 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 Jan 6, 2017; 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.