Active NPI
Susan Park, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- North Syracuse, NY
National Provider Identifier
1821147190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 048609-1
- Practice address
- 709 N Main St
North Syracuse, NY 13212-1669 - Phone
- (315) 452-5915
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 048609-1 | NY | Primary |
Addresses
Primary practice location
709 N Main St
North Syracuse, NY 13212-1669
Mailing address
3850 N Causeway Blvd
Suite 800
Metairie, LA 70002-1752
Phone (800) 622-7645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048609-1 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282608000000",
"number": "1821147190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3850 N CAUSEWAY BLVD",
"address_2": "SUITE 800",
"city": "METAIRIE",
"state": "LA",
"postal_code": "700021752",
"telephone_number": "800-622-7645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 N MAIN ST",
"city": "NORTH SYRACUSE",
"state": "NY",
"postal_code": "132121669",
"telephone_number": "315-452-5915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "SUSAN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2010-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "048609-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.