NPIMap

Organization Active NPI

Park Dentistry LLC

  • General Practice Dentistry
  • West Allis, WI
National Provider Identifier
1902566003
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PARK DENTISTRY LLC
Practice address
1947 S 60TH St
West Allis, WI 53219-1552
Phone
(414) 545-6747
Fax
(414) 545-2488
NPI assigned
Dec 30, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Authorized official

Name
Dr. Joon Jae Park, DDS
Title
Owner
Phone
(414) 545-6747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1947 S 60TH St
West Allis, WI 53219-1552

Mailing address

1947 S 60TH St
West Allis, WI 53219-1552
Phone (414) 545-6747

Other names 1

  • Gentle Smiles Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1947 S 60th St
West Allis, WI 53219
Phone (414) 545-6747

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1902566003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1947 S 60TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532191552",
            "telephone_number": "414-545-6747",
            "fax_number": "414-545-2488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 S 60TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532191552",
            "telephone_number": "414-545-6747",
            "fax_number": "414-545-2488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-30",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JOON JAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-545-6747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gentle Smiles Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Allis, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.