Jonathan J Park, D.M.D.,M.D. is an oral and maxillofacial surgery dentist in Fairfax, VA. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Jonathan J Park, D.M.D.,M.D. NPI is 1114940905. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
10530 ROSEHAVEN ST
SUITE 111
FAIRFAX, VA
ZIP 22030-840
Phone: (703) 385-5777
Fax: (703) 591-5386
The NPI 1114940905 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).
The enumeration date for this NPI number is 7/25/2006 and was last updated on 7/8/2007.