Ryan Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1588235196 Issued in MA

Practice address

1138 River St
Hyde Park, MA 02136-2970

Phone

(617) 361-5020

NPI assigned

Jul 6, 2021

Sex

Male

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

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.

• Ace Dental West Roxbury, PLLC

  • Dental Clinic/Center
  • West Roxbury, MA
  • NPI 1679225114
  NPD (past)

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654905600000",
    "number": "1588235196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 STRATFORD ST",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021322008",
            "telephone_number": "857-210-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 RIVER ST",
            "city": "HYDE PARK",
            "state": "MA",
            "postal_code": "021362970",
            "telephone_number": "617-361-5020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Asylum Ave",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061051770",
            "country_code": "US",
            "telephone_number": "860-714-4995",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1840 Centre St",
            "address_purpose": "LOCATION",
            "city": "West Roxbury",
            "state": "MA",
            "postal_code": "021321901",
            "country_code": "US",
            "telephone_number": "617-327-5700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "RYAN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-06",
        "last_updated": "2022-06-11",
        "certification_date": "2022-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "1588235196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edith Onwuakor
• Gecinda Orelus
• Assumpta Uzoma Orjiakor
• Brie Ostreicher
• Park Place LLC
• Parkwell Healthcare LLC
• Gunjanbhai Rameshbhai Patel, DMD
• Marie Auxiliatrice Paul
• Patrick Evans Paul
• Gerda Paulissaint

• General Practice Dentistry in Hyde Park, MA
• Providers in Hyde Park, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2022; 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.