Dean Moon Park, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

019020375 Issued in IL

Practice address

417 S Lincolnway
Suite a
North Aurora, IL 60542-5109

Phone

(630) 897-1300

Fax

(630) 897-7172

NPI assigned

Apr 23, 2008

Sex

Male

Sole proprietor

No

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

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Lincolnway Dental Center, PC

  • General Practice Dentistry
  • North Aurora, IL
  • NPI 1801963558
  NPD (past) Authorized official

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1679748586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 S LINCOLNWAY",
            "address_2": "SUITE A",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605425109",
            "telephone_number": "630-897-1300",
            "fax_number": "630-897-7172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S LINCOLNWAY",
            "address_2": "SUITE A",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605425109",
            "telephone_number": "630-897-1300",
            "fax_number": "630-897-7172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DEAN",
        "middle_name": "MOON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019020375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sylvia Ortiz-Kennedy, BSW MSW QMHP
• Brahim Ouais, D.C.
• Out & About Transportation Inc
• Park Clinical Services, PLLC
• Bill M Park, O.D.
• Lena G Park, O.D.
• Marycarol Park, LCPC
• Ankit Patel
• Niravkumar Patel
• Patricia Zacharias LCPC LLC

• Dentist in North Aurora, IL
• Providers in North Aurora, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.