Provider Demographics
NPI:1871754630
Name:PARK, ANNA K
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:K
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9409
Mailing Address - Country:US
Mailing Address - Phone:856-478-9500
Mailing Address - Fax:856-478-9547
Practice Address - Street 1:50 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9409
Practice Address - Country:US
Practice Address - Phone:856-478-9500
Practice Address - Fax:856-478-9547
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10212701223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics