Clean Dental of Dallas, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

23653 Issued in TX

Legal business name

CLEAN DENTAL OF DALLAS, P.C.

Doing business as

Clean Dental

Practice address

4907 Spring Ave
Dallas, TX 75210-1360

Phone

(214) 765-6212

NPI assigned

Jul 18, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Sang W Park, DDSNPI 1275717928

Title

Ceo

Phone

(214) 765-6213

Specialties & licenses 1

Addresses

Other names 1

• Clean Dental Doing business as

Practitioners 1

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

• Sang Park

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1275717928
  NPD (past) Authorized official

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342569600000",
    "number": "1912252750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 GUS THOMASSON RD",
            "address_2": "SUITE A",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751502232",
            "telephone_number": "214-765-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4907 SPRING AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752101360",
            "telephone_number": "214-765-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN DENTAL OF DALLAS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2012-07-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "SANG",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-765-6213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clean Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dessirae Clayton
• Jamon William Clayton, DC
• Joshua Thomas Clayton
• Kortnie Marie Clayton, OTD, OTR/L
• Matthew S Clayton, CRNA
• Clean Heart Home Health Care Inc
• Clear Associates PLLC
• Clear Associates PLLC
• Clear Dot Inc. (Clear Dot Health)
• Clear Horizon Therapy PLLC

• General Practice Dentistry in Dallas, TX
• Providers in Dallas, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; 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.