Active NPI
Ilmoon Park, DMD
- General Practice Dentistry
- Winter Haven, FL
National Provider Identifier
1932483849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN19565
- Practice address
- 3265 Cypress Gardens Rd
Suite a
Winter Haven, FL 33884-2418 - Phone
- (863) 324-4271
- NPI assigned
- Oct 11, 2011
- Last updated
- Aug 10, 2015
- Sex
- Male
- 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 | DN19565 | FL | Primary |
Addresses
Primary practice location
3265 Cypress Gardens Rd
Suite a
Winter Haven, FL 33884-2418
Mailing address
3265 Cypress Gardens Rd
Suite a
Winter Haven, FL 33884-2418
Phone (863) 324-4271
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN19565 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439164800000",
"number": "1932483849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3265 CYPRESS GARDENS RD",
"address_2": "SUITE A",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338842418",
"telephone_number": "863-324-4271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3265 CYPRESS GARDENS RD",
"address_2": "SUITE A",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338842418",
"telephone_number": "863-324-4271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "ILMOON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-11",
"last_updated": "2015-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN19565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.