Diana Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30024229 Issued in OH

Practice address

877 Eastwind Dr
Westerville, OH 43081-3309

Phone

(614) 794-4000

NPI assigned

May 6, 2014

Last updated

Feb 24, 2016By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1399334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456272000000",
    "number": "1518377969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 EASTWIND DR",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430813309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 EASTWIND DR",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430813309",
            "telephone_number": "614-794-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DIANA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-06",
        "last_updated": "2016-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30024229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0129077",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lorin Pankewicz, M.A., CCC-SLP
• Thien-Khanh Ngoc Pantelis, PHARMD
• Ellen M Papadeas, M.A. LPCC AND LMHC
• Paramount Senior Living at Polaris, LLC (Paramount Senior Living at Polaris)
• Park Dental Westerville, LLC
• Julie Lee Park, DMD
• Abby M Parker, MA, BCBA, COBA
• Devine Parker, RBT
• Elizabeth Parker
• Katherine Elizabeth Parker, CNP

• General Practice Dentistry in Westerville, OH
• Providers in Westerville, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.