NPIMap

Organization Active NPI

D Park MPH Dental, Inc.

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1508462649
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
D PARK MPH DENTAL, INC.
Practice address
12021 S. Wilmington Ave Ste 1100
Los Angeles, CA 90059-3019
Phone
(888) 585-3368
Fax
(661) 471-2121
NPI assigned
Dec 4, 2020
Organization subpart
Yes
Parent organization
D PARK MPH DENTAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Authorized official

Name
David S Park
Title
Dentist
Phone
(310) 403-1117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

12021 S. Wilmington Ave Ste 1100
Los Angeles, CA 90059-3019

Mailing address

12021 S. Wilmington Ave Ste 1100
Los Angeles, CA 90059-3019
Phone (888) 585-3368

Other names 1

  • Smile Dental of MLK Doing business as

National Provider Directory

National Provider Directory
Tax ID family
D Park MPH Dental Inc3 organizations share this tax ID, including this one
Part of
D Park MPH Dental Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12021 Wilmington Ave
Ste 1100
Los Angeles, CA 90059
Phone (888) 585-3368

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1508462649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 S. WILMINGTON AVE STE 1100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "888-585-3368",
            "fax_number": "661-471-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 S. WILMINGTON AVE STE 1100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "888-585-3368",
            "fax_number": "661-471-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D PARK MPH DENTAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "D PARK MPH DENTAL, INC.",
        "enumeration_date": "2020-12-04",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "310-403-1117"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Dental of MLK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smile Dental of MLK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; 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.