NPIMap

Organization Active NPI

Park Family Dental LLC

  • Dental Clinic/Center
  • South Milwaukee, WI
National Provider Identifier
1720791817
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PARK FAMILY DENTAL LLC
Practice address
1001 Madison Ave
South Milwaukee, WI 53172-2500
Phone
(414) 203-9664
NPI assigned
Jan 4, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Authorized official

Name
Dr. Joon Jae Park, DDSNPI 1568817559
Title
Owner
Phone
(262) 720-4669

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1001 Madison Ave
South Milwaukee, WI 53172-2500

Mailing address

W201N5244 Sandpiper LN
Menomonee Falls, WI 53051-6209
Phone (262) 720-4669

National Provider Directory

National Provider Directory

Locations

1001 Madison Ave
South Milwaukee, WI 53172
Phone (414) 203-9664

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1720791817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W201N5244 SANDPIPER LN",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530516209",
            "telephone_number": "262-720-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MADISON AVE",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531722500",
            "telephone_number": "414-203-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-04",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JOON JAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-720-4669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.