PARK PROFESSIONAL DENTAL CORP (NPI# 1386135671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386135671 |
| Entity Type | Organization |
| Organization Name | PARK PROFESSIONAL DENTAL CORP |
| Other Organization Name | SMILE DENTAL OF LOS ANGELES |
| Practice Address |
600 W Manchester Ave Ste 2 Los Angeles CA 90044 |
| Mailing Address |
600 W Manchester Ave Ste 2 Los Angeles CA 90044-5700 |
| Practice Telephone | 3237501582 |
| Mailing Telephone | 3237501582 |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2018-07-03 |
| Authorized Official Name | MICHELLE PEEVY (RDO) |
| Authorized Official Telephone | 6614303283 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 53724 | CA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 53724 | 05 |
| Other Name | Type Code |
|---|---|
| Smile Dental of Los Angeles | Doing Business As Name - Organization |
| Street Address |
600 W MANCHESTER AVE STE 2 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90044 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851831218 | Latisha Samantha Carter | Licensed Vocational Nurse | 521 W 97th St., Los Angeles, CA 90044 | 2017-03-06 |
| 1669928230 | Travel & Ground Network Inc. | Non-emergency Medical Transport (VAN) | 605 West 113 Th. Street, Los Angeles, CA 90044 | 2016-09-01 |
| 1295100642 | Scharp | Community/Behavioral Health | 8836 Vermont Ave, Los Angeles, CA 90044 | 2015-12-10 |
| 1356714851 | Euna Lee | Pharmacist | 5822 S Vermont Avenue, Los Angeles, CA 90044 | 2015-11-05 |
| 1518384338 | Kiniko Willingham | Social Worker | 1050 W 91st St, Los Angles, CA 90044 | 2014-03-19 |
| 1619211422 | Los Angeles Christian Health Centers | Clinic/Center | 8511 1/2 Vermont Street, Los Angeles, CA 90044 | 2012-11-16 |
| 1891047510 | Yvonne Henderson | Marriage & Family Therapist | 8730 S. Vermont Ave, Los Angeles, CA 90044 | 2012-10-04 |
| 1669722534 | Diana Gutierrez | Counselor | 9001 S. Vermont Ave., Los Angeles, CA 90044 | 2012-09-18 |
| 1720343304 | Rocio Cortez | Counselor | 90001 South Vermont Ave, Los Angeles, CA 90044 | 2012-07-10 |
| 1306105077 | Samet Dental Corp | Dentist | 5877 S Vernont Avenue, Los Angeles, CA 90044 | 2012-05-15 |
| Find all providers in zip 90044 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992481 | Centinela Joseph Dental Group | Dentist | 6907 La Tijera Blvd, Los Angeles, CA 90045-1906 | 2020-11-02 |
| 1134729601 | Enas Tayyem | Dentist | 2100 N Beachwood Dr Apt 303, Los Angeles, CA 90068-3442 | 2020-10-26 |
| 1639776073 | Stephanie Jeanne Bauman | Dentist | 3060 W Olympic Blvd Apt 438, Los Angeles, CA 90006-3838 | 2020-10-08 |
| 1316544570 | Azzah Widatalla | Dentist | 5455 Wilshire Blvd Ste 850, Los Angeles, CA 90036-4234 | 2020-10-01 |
| 1104433796 | Irena Starchenko | Dentist | 2007 Wilshire Blvd Ste 525, Los Angeles, CA 90057-3518 | 2020-09-28 |
| 1134734353 | Mark Park | Dentist | 404 Shatto Pl Apt 443, Los Angeles, CA 90020-1739 | 2020-09-14 |
| 1740895150 | Chantelle Aabedi | Dentist | 2711 Casiano Rd, Los Angeles, CA 90077-9007 | 2020-09-11 |
| 1801401542 | Yojeong Cho | Dentist | 621 S Western Ave Ste 201, Los Angeles, CA 90005-3042 | 2020-09-10 |
| 1518572247 | William Hwang | Dentist | 2727 W Olympic Blvd Ste 311, Los Angeles, CA 90006-2699 | 2020-09-10 |
| 1912511056 | Shervin Moshashaei | Dentist | 1420 Peerless Pl Apt 212, Los Angeles, CA 90035-2869 | 2020-09-05 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90044 |
Please comment or provide details below to improve the information on PARK PROFESSIONAL DENTAL CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.