Park Pediatric Dentistry of Woodstock, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013851 Issued in GA

Legal business name

PARK PEDIATRIC DENTISTRY OF WOODSTOCK, LLC

Practice address

1816 Eagle Dr
Suite 200-C
Woodstock, GA 30189-8272

Phone

(770) 926-9260

Fax

(770) 926-9263

NPI assigned

Oct 24, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Julius Park, DMDNPI 1710022942

Title

Ceo

Phone

(770) 926-9260

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Julius Park, D.M.D.

  • Pediatric Dentistry
  • Woodstock, GA
  • NPI 1710022942
  NPD (past) Authorized official

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

{
    "created_epoch": "1287878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287878400000",
    "number": "1346540432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 EAGLE DR",
            "address_2": "SUITE 200-C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898272",
            "telephone_number": "770-926-9260",
            "fax_number": "770-926-9263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 EAGLE DR",
            "address_2": "SUITE 200-C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898272",
            "telephone_number": "770-926-9260",
            "fax_number": "770-926-9263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK PEDIATRIC DENTISTRY OF WOODSTOCK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-24",
        "last_updated": "2010-10-24",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-926-9260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rohit Panchal, MD
• Colleen P Panunzio, MA,LPC
• Kathryn Pape
• Raul E. Paraliticci, MD
• Katryn Marie Parillo, CSA
• Jane Park
• Jihe Park
• Julius Park, D.M.D.
• Stacy Shoemake Park, PHARMD
• Anna Parker, PHARMD

• Pediatric Dentistry in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2010; 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.