Lucienne Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN27006 Issued in FL

Practice address

5753 Beach Blvd Ste 4
Jacksonville, FL 32207-5128

Phone

(904) 441-1642

NPI assigned

Jun 16, 2021

Sex

Female

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)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ideal Dental South Jacksonville PLLC

  • Dentist
  • Jacksonville, FL
  • NPI 1255067179
  NPD

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1497323315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5753 BEACH BLVD STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5753 BEACH BLVD STE 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075128",
            "telephone_number": "904-441-1642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "LUCIENNE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-16",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN27006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Hyunjung Park-Nah, DDS
• Charles Sue Park, MD
• Chin W. Park
• Kwang SE Park, M.D.
• Lauren Park
• Michelle Park
• Minnsun Koh Park, M.D.
• Shin Park
• Yong S Park, DMD
• John C Parke, PA-C

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, 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 Jun 6, 2025; 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.