Charlie Park

Primary specialty

DentistTaxonomy code 122300000X

License

DS038502 Issued in PA

Practice address

401 Commerce Dr
Suite 108
Ft Washington, PA 19034-2714

Phone

(267) 460-4254

NPI assigned

May 12, 2008

Last updated

Mar 5, 2012By 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

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.

Opted out of Medicare

Yes, effective Mar 31, 2017 through Mar 31, 2027

Medicare enrollment (NPD)

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

• Chevy Chase Implant & Oral Surgery. L.L.C.

  • Oral and Maxillofacial Surgery Clinic/Center
  • Chevy Chase, MD
  • NPI 1518329614
  NPD (past) Authorized official

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330905600000",
    "number": "1598932212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 COMMERCE DR",
            "address_2": "SUITE 108",
            "city": "FT WASHINGTON",
            "state": "PA",
            "postal_code": "190342714",
            "telephone_number": "267-460-4254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 COMMERCE DR",
            "address_2": "SUITE 108",
            "city": "FT WASHINGTON",
            "state": "PA",
            "postal_code": "190342714",
            "telephone_number": "267-460-4254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CHARLIE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-12",
        "last_updated": "2012-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS038502",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kehinde Oyelakim
• Larissa Page
• Elizabeth Pak, CRNP
• Alexandra Pappas, LCSW
• Pratyush Parasana
• Cherline Pascal, LPN
• Andrew Gennaro Passerini
• Krupa K Patel, MD
• Jessica Pell
• Minerva Pena, LPN

• Dentist in Fort Washington, PA
• Providers in Fort Washington, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.