Park DDS MPH Inc

Primary specialty

DentistTaxonomy code 122300000X

License

53724 Issued in CA

Legal business name

PARK DDS MPH INC

Doing business as

Galt Dental Group

Practice address

1067 C St
125
Galt, CA 95632-1757

Phone

(209) 744-0463

Fax

(209) 744-8845

NPI assigned

Mar 20, 2014

Organization subpart

No

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

Authorized official

Name

David S Park, DDS

Title

Owner

Phone

(209) 744-0463

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Galt Dental Group Doing business as

Locations

Practitioners 3

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

• Nancy Nam Tran Nguyen, DDS

  • Dentist
  • Galt, CA
  • NPI 1689050346
  NPD (past)
• Hansel Poerwanto, DDS

  • Dentist
  • Sacramento, CA
  • NPI 1629521703
  NPD (past)
• Ji H Baag, DDS

  • Endodontics
  • Las Vegas, NV
  • NPI 1689875395
  NPD (past)

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1801213442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1067 C ST",
            "address_2": "125",
            "city": "GALT",
            "state": "CA",
            "postal_code": "956321757",
            "telephone_number": "209-744-0463",
            "fax_number": "209-744-8845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1067 C ST",
            "address_2": "125",
            "city": "GALT",
            "state": "CA",
            "postal_code": "956321757",
            "telephone_number": "209-744-0463",
            "fax_number": "209-744-8845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK DDS MPH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-03-20",
        "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": "209-744-0463",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "53724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53274",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galt Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keith K Ota, BS
• Cecelia Marie Overton
• Ronald T Oye, OD
• Sherley Pabustan
• Ariana Pantoja Perez, LMFT
• Colton Daniel Parson
• Ma Theresa Pascual, LVN
• Nikita Patel, PT
• Jazmin Palacios Peguero, PPS
• Peggy Phelps

• Dentist in Galt, CA
• Providers in Galt, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.