NPIMap

Organization Active NPI

Dr D S Park Dental Inc

Doing business as Smile Dental of Wasco

  • Dentist
  • Wasco, CA
National Provider Identifier
1760025589
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DR D S PARK DENTAL INC
Doing business as
Smile Dental of Wasco
Practice address
1245 7TH St
Wasco, CA 93280-1820
Phone
(661) 758-3021
Fax
(661) 758-6780
NPI assigned
Oct 24, 2019
Last updated
Dec 4, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DR D S PARK DENTAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Authorized official

Name
Dr. David S Park, DDSNPI 1942410501
Title
Owner
Phone
(310) 403-1117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

1245 7TH St
Wasco, CA 93280-1820

Mailing address

1245 7TH St
Wasco, CA 93280-1820
Phone (661) 758-3021

Other identifiers 1

IdentifierTypeStateIssuer
53724MedicaidCA

Other names 1

  • Smile Dental of Wasco Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dr D S Park Dental Inc2 organizations share this tax ID, including this one
Part of
Dr D S Park Dental Inc

Other organizations with this tax ID 1

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

Locations

1245 7th St
Wasco, CA 93280
Phone (661) 758-3021

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1571875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1760025589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 7TH ST",
            "city": "WASCO",
            "state": "CA",
            "postal_code": "932801820",
            "telephone_number": "661-758-3021",
            "fax_number": "661-758-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 7TH ST",
            "city": "WASCO",
            "state": "CA",
            "postal_code": "932801820",
            "telephone_number": "661-758-3021",
            "fax_number": "661-758-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR D S PARK DENTAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DR D S PARK DENTAL INC",
        "enumeration_date": "2019-10-24",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-403-1117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "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 Wasco",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wasco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.