Julius Park, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013851 Issued in GA

Practice address

1816 Eagle Dr
200-C
Woodstock, GA 30189-8272

Phone

(770) 926-9260

Fax

(770) 926-9263

NPI assigned

Feb 21, 2007

Last updated

Sep 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

• Park Pediatric Dentistry of Woodstock, LLC

  • Pediatric Dentistry
  • Woodstock, GA
  • NPI 1346540432
  NPD (past) Authorized official

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1710022942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 EAGLE DR",
            "address_2": "200-C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898272",
            "telephone_number": "770-926-9260",
            "fax_number": "770-926-9263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 EAGLE DR",
            "address_2": "200-C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898272",
            "telephone_number": "770-926-9260",
            "fax_number": "770-926-9263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JULIUS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02198100",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "050223",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02731033",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raul E. Paraliticci, MD
• Katryn Marie Parillo, CSA
• Park Pediatric Dentistry of Woodstock, LLC
• Jane Park
• Jihe Park
• Stacy Shoemake Park, PHARMD
• Anna Parker, PHARMD
• Ashley Nicole Parker, OTD R/L
• Taylor Nicole Parks, MS
• Parkside Optique, LLC

• Pediatric Dentistry in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; 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.