Active NPI
Mimi E Park, DDS
- General Practice Dentistry
- Midlothian, VA
National Provider Identifier
1861705675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0401-412922
- Practice address
- 14420 Sommerville CT
Midlothian, VA 23113-6835 - Phone
- (804) 897-7900
- Fax
- (804) 897-4048
- NPI assigned
- Jul 21, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401-412922 | VA | Primary |
Addresses
Primary practice location
14420 Sommerville CT
Midlothian, VA 23113-6835
Mailing address
14420 Sommerville CT
Midlothian, VA 23113-6835
Phone (804) 897-7900
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401-412922 | VA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279670400000",
"number": "1861705675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14420 SOMMERVILLE CT",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231136835",
"telephone_number": "804-897-7900",
"fax_number": "804-897-4048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14420 SOMMERVILLE CT",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231136835",
"telephone_number": "804-897-7900",
"fax_number": "804-897-4048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MIMI",
"middle_name": "E",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-21",
"last_updated": "2010-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0401-412922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midlothian, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.