Chin S Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

FP2954899 Issued in GA

Practice address

2415 W Park Place Blvd
Stone Mountain, GA 30087-3566

Phone

(770) 879-1200

Fax

(770) 413-1821

NPI assigned

Feb 16, 2012

Last updated

Sep 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elite Dental Management Inc

  dba Riverside Family Dental

  • Dental Clinic/Center
  • Lawrenceville, GA
  • NPI 1699588178
  NPD Authorized official
• SM Dentistry Inc

  dba Park Family Dentistry

  • Dentist
  • Stone Mountain, GA
  • NPI 1124854096
  NPD Authorized official
• Metro Dental LLC

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1306056023
  NPD (past)

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1508139890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 W PARK PLACE BLVD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873566",
            "telephone_number": "770-879-1200",
            "fax_number": "770-413-1821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 W PARK PLACE BLVD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873566",
            "telephone_number": "770-879-1200",
            "fax_number": "770-413-1821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-16",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014213",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "FP2954899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paradise for Living Services, Inc.
• Paramount Healthcare Professionals, LLC
• Park Springs, LLC (Pebblebrook Health Center at Park Springs)
• Park Springs, LLC (Park Springs Home Care)
• Park Springs, LLC (Park Springs Wellness Clinic)
• Dawn Ledford Parker, NP-C
• Erin Parks
• Parrott Solutions, LLC
• Thomas B Parrott, M.D.
• Katherine J Parson, M. ED.,PT

• General Practice Dentistry in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.