Ian Anthony Park, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9986 Issued in MN

Practice address

17705 Hutchins Dr
Suite 209
Minnetonka, MN 55345-4145

Phone

(925) 474-8114

Fax

(952) 474-5195

NPI assigned

Aug 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Ian Park DDS PA

  • General Practice Dentistry
  • Minnetonka, MN
  • NPI 1891986378
  NPD (past) Authorized official

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861494791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR",
            "address_2": "SUITE 209",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454145",
            "telephone_number": "925-474-8114",
            "fax_number": "952-474-5195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR",
            "address_2": "SUITE 209",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454145",
            "telephone_number": "925-474-8114",
            "fax_number": "952-474-5195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "IAN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lesley Palmer
• Callie Papa, MA, LMFT
• Paige Elise Paquette
• Riyana Parekh
• Park Nicollet Health Care Products
• Jaemin Park
• Partners in Healing of Minneapolis
• Partners in Healing of Minneapolis
• Partners in Healing of Minneapolis
• Partners in Healing of Minneapolis, LLC

• General Practice Dentistry in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.