D Park MPH DDS Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

D PARK MPH DDS DENTAL CORPORATION

Doing business as

Smile Dental of Tracy

Practice address

2616 Pavilion Pkwy Ste 104
Tracy, CA 95304-9408

Phone

(209) 839-8333

Fax

(209) 839-8338

NPI assigned

May 11, 2021

Organization subpart

Yes

Parent organization

D PARK MPH DDS DENTAL CORPORATIONAs reported in NPPES

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

Authorized official

Name

David S Park

Title

DDS/Ceo

Phone

(310) 403-1117

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SMILE DENTAL OF TRACY Doing business as

Tax ID family

D Park MPH DDS Dental Corporation2 organizations share this tax ID, including this one

Part of

D Park MPH DDS Dental Corporation

Other organizations with this tax ID 1

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

• D Park MPH DDS Dental Corporation

  dba Pacific Dental Group

  • General Practice Dentistry
  • Stockton, CA
  • NPI 1124572284
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashu Sharma

  • Dentist
  • Tracy, CA
  • NPI 1194200865
  NPD

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1609450006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2616 PAVILION PKWY STE 104",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953049408",
            "telephone_number": "209-839-8333",
            "fax_number": "209-839-8338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2616 PAVILION PKWY STE 104",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953049408",
            "telephone_number": "209-839-8333",
            "fax_number": "209-839-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D PARK MPH DDS DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "D PARK MPH DDS DENTAL CORPORATION",
        "enumeration_date": "2021-05-11",
        "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": "DDS/CEO",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53724",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMILE DENTAL OF TRACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMILE DENTAL OF TRACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal Nerence Gomez Cunanan, RPT
• Anale C. Cunningham, MD
• Madison Alice Cunningham
• Frederick Curtis, P.A.
• Takeya Cutrer
• Madelyn Dabandan
• Basira Dadajan
• Ekaterina Dadgar
• Stephanie Dais
• Deepthy Damien, M.D.

• General Practice Dentistry in Tracy, CA
• Providers in Tracy, CA by specialty
• General Practice Dentistry in California

• 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.