Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 11229 | NC |
NPI | 1174025621 |
---|---|
Provider Name | Dr. Sarah Park |
First Address | Chapel Hill, NC 27516 |
Second Address | San Francisco, CA 94121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2018 |
Last Update Date | 31/08/2021 |