Aaron Park, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9268 Issued in NC

Practice address

1107 S Fifth St Ste 250
Mebane, NC 27302-9896

Phone

(919) 563-2873

Fax

(919) 563-2876

NPI assigned

Sep 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 2, 2013 through Dec 2, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: apark49354@direct.medicine.duke.edu

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

{
    "created_epoch": "1188691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511308800000",
    "number": "1861686875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 S FIFTH ST STE 250",
            "city": "MEBANE",
            "state": "NC",
            "postal_code": "273029896",
            "telephone_number": "919-563-2873",
            "fax_number": "919-563-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 S FIFTH ST STE 250",
            "city": "MEBANE",
            "state": "NC",
            "postal_code": "273029896",
            "telephone_number": "919-563-2873",
            "fax_number": "919-563-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-02",
        "last_updated": "2017-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "052778",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NC",
            "license": "2017-02466",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "269639",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "9268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5919946",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02888484",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Mebane, NC
• Providers in Mebane, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.