Matthew Tae Park DDS

NPI 1023225513 - Dentist - 122300000X

NPI Details
NPI 1023225513
Gender Male
Enumeration Date 05/16/2007
Last Updated 08/28/2014
Entity Type Individual
Active Over 9 years ago
Practice Location
1902 E. IRELAND RD
SOUTH BEND IN, 46614, US
Phone (574) 291-8022
Fax (574) 291-7868
Business Location
1902 E. IRELAND RD.
SOUTH BEND IN, 46614, US
Phone (574) 291-8022
Fax (574) 291-7868
Toxanomy
Taxonomy Code 122300000X
License State Indiana
License Number 12010713A
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According to our database, Dr. Matthew Tae Park DDS NPI is 1023225513, taxonomy code is 122300000X and license number is 12010713A, license state is located at Indiana. Matthew Tae Park DDS physically located at 1902 E. Ireland Rd, South Bend IN, 46614. NPI Number Matthew Tae Park DDS has the Individual type.

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1023225513 NPI number is provided on an as is basis without warranty of any kind. 1023225513 is maintained by the National Plan & Provider Enumeration System. The contents of Matthew Tae Park DDS are for informational purposes only.