| Mindy Park Dds Inc | |
|
8345 Reseda Blvd Ste 101 Northridge CA 91324-4648 | |
| (818) 576-9990 | |
| Not Available |
| Full Name | Mindy Park Dds Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8345 Reseda Blvd Ste 101, Northridge, California |
| Authorized Official Name and Position | Mindy Park (DENTIST/OWNER) |
| Authorized Official Contact | 8185769990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindy Park Dds Inc 8345 Reseda Blvd Ste 101 Northridge CA 91324-4648 Ph: (818) 576-9990 | Mindy Park Dds Inc 8345 Reseda Blvd Ste 101 Northridge CA 91324-4648 Ph: (818) 576-9990 |
| NPI Number | 1063231090 |
|---|---|
| Provider Enumeration Date | 10/07/2024 |
| Last Update Date | 10/07/2024 |
| Medicare PECOS PAC ID | 7810425451 |
|---|---|
| Medicare Enrollment ID | O20250110001787 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063231090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Mindy M Park |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1417257767 PECOS PAC ID: 8628335502 Enrollment ID: I20171130002827 |
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