NPIMap

Organization Active NPI

David S Park DDS Inc

Doing business as El Centro Dental Group

  • Dentist
  • El Centro, CA
National Provider Identifier
1346659562
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
53724 Issued in CA
Legal business name
DAVID S PARK DDS INC
Doing business as
El Centro Dental Group
Practice address
617 S 8TH St
El Centro, CA 92243-3218
Phone
(760) 312-5888
Fax
(760) 312-5918
NPI assigned
Aug 13, 2014
Last updated
Dec 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Authorized official

Name
David S Park, DDSNPI 1942410501
Title
Owner
Phone
(310) 403-1117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 53724 CA Primary

Addresses

Primary practice location

617 S 8TH St
El Centro, CA 92243-3218

Mailing address

617 S 8TH St
El Centro, CA 92243-3218
Phone (760) 312-5888

Other identifiers 1

IdentifierTypeStateIssuer
53724MedicaidCA

Other names 1

  • El Centro Dental Group Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1346659562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 S 8TH ST",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922433218",
            "telephone_number": "760-312-5888",
            "fax_number": "760-312-5918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 S 8TH ST",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922433218",
            "telephone_number": "760-312-5888",
            "fax_number": "760-312-5918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID S PARK DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-403-1117",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "53724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53724",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Centro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.