| NPI | 1497309413 |
|---|---|
| Professional Name | SUSAN S PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062118) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2021-10-11 |