Individual provider · Type 1 NPI

Jonathan J. Park, DMD, MD

Oral and Maxillofacial Surgery (Dentist) · Fairfax, VA

NPI number 1114940905 Active

Practice location

10530 Rosehaven St, Suite 111
Fairfax, VA 22030-2840

Call (703) 385-5777 Map

Fax (703) 591-5386

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X0101221324 (VA)

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes 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.

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About NPI 1114940905

Jonathan J. Park, DMD, MD's National Provider Identifier is 1114940905, issued on Jul 25, 2006. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Fairfax, VA. The record was last updated on Jul 8, 2007.