SEONG JIN PARK (NPI# 1629682943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629682943 |
| Entity Type | Individual |
| Full Name | SEONG JIN PARK |
| Practice Address |
6958 Nebraska Ave Bldg 1608 Fort Leonard Wood MO 65473-1618 |
| Practice Telephone | 5735960408 |
| Mailing Telephone | 5735960408 |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2020-09-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | Dental Providers |
| Street Address |
6958 NEBRASKA AVE BLDG 1608 |
| City | FORT LEONARD WOOD |
| State | MO |
| Zip Code | 65473-1618 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346855137 | Jorge Aori Martell | Dental Hygienist | 6958 Nebraska Ave Bldg 1608, Fort Leonard Wood, MO 65473-1618 | 2020-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770192759 | Clara Boo Chai | Physician Assistant | General Leonard Wood Army Community Hospital, 4430 Missouri Ave, #1267, Fort Leonard Wood, MO 65473 | 2020-07-27 |
| 1982198453 | Traci Anne Shambo | Dental Hygienist | Bldg. 400 Virginia Ave, Fort Leonard Wood, MO 65473 | 2018-06-19 |
| 1083133771 | Mary Joan Klemp | Family Medicine | Ganeral Leonard Wood Army Community Hospital, 4430 Missouri Ave; Meddac Case Management; Primary Care, Fort Leonard Wood, MO 65473 | 2017-09-13 |
| 1255791851 | Sarah Elizabeth Joy | Physician Assistant | 885 West 16th Street, Fort Leonard Wood, MO 65473 | 2016-02-25 |
| 1548626948 | Jaimie-lee Musen | Physical Therapist | 4430 Missouri Ave, Glwach, Fort Leonard Wood, MO 65473 | 2016-01-14 |
| 1609240852 | Angela Carson | Registered Nurse | 4330 Missouri Avenue, Fort Leonard Wood, MO 65473 | 2015-11-25 |
| 1811379407 | Katharine Leigh Stringer | Dentist | 12720 Kansas Avenue, Fort Leonard Wood, MO 65473 | 2015-06-19 |
| 1548656044 | General Leonard Wood Army Community Hospital | Clinic/Center | 12720 Kansas Ave, Bldg 789, Fort Leonard Wood, MO 65473 | 2015-04-10 |
| 1740670314 | Terricka Stewart | Specialist/Technologist | 885 West 16th St., Fort Leonard Wood, MO 65473 | 2015-02-03 |
| 1427467265 | Dianna Morrison | Social Worker | 4430 Missouri Ave Box 1278, Fort Leonard Wood, MO 65473 | 2014-08-06 |
| Find all providers in zip 65473 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982198453 | Traci Anne Shambo | Dental Hygienist | Bldg. 400 Virginia Ave, Fort Leonard Wood, MO 65473 | 2018-06-19 |
| 1497105688 | Lisa Diane Moss | Dental Hygienist | 5047 Virginia Ave, Bldg 500, Fort Leonard Wood, MO 65473-9126 | 2016-06-17 |
| 1346855137 | Jorge Aori Martell | Dental Hygienist | 6958 Nebraska Ave Bldg 1608, Fort Leonard Wood, MO 65473-1618 | 2020-09-09 |
| 1922451277 | April Bliss | Dental Hygienist | 5047 Virginia Ave, Bldg 500, Fort Leonard Wood, MO 65473-9126 | 2016-07-21 |
| 1497108773 | Jeri Denise Trammel | Dental Hygienist | 5047 Virginia Ave, Bldg 500, Fort Leonard Wood, MO 65473-9126 | 2016-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194323238 | Marcia Poe | Dental Hygienist | 20815 S Dean Rd, Belton, MO 64012-9132 | 2020-10-12 |
| 1447868542 | Emily Sue Leslie | Dental Hygienist | 315 W Mulberry Ste B, Pilot Knob, MO 63663-7860 | 2020-07-15 |
| 1396237863 | Maegen Mone Taylor | Dental Hygienist | 547 S Business Highway 13, Lexington, MO 64067 | 2018-05-31 |
| 1740798750 | Julie R Phillips | Dental Hygienist | 10007 Nw Lema Dr Apt C, Parkville, MO 64152-3933 | 2018-01-12 |
| 1639618325 | Tabitha Vollmer | Dental Hygienist | 1701 W. Sunshine Street, Suite Q, Springfield, MO 65807-2261 | 2017-02-15 |
| 1588113773 | Heather Annette Henke | Dental Hygienist | #5 Health Department Drive, Troy, MO 63379-4451 | 2016-09-28 |
| 1720532104 | Angela Faurot | Dental Hygienist | 4001 Pine View Dr, Columbia, MO 65202-4209 | 2016-08-15 |
| 1972986602 | Crystal Moser | Dental Hygienist | 2612 W Cover Dr, Ozark, MO 65721-5469 | 2015-06-30 |
| 1003295460 | Kyra J Tracy | Dental Hygienist | 608 S Missouri St., Waverly, MO 64096 | 2015-05-19 |
| 1770981821 | Daniel Warner | Dental Hygienist | 4955 S National Ave, Springfield, MO 65810-2989 | 2014-12-05 |
| Find all providers with the same taxonomy | ||||
| City | FORT LEONARD WOOD |
| Zip Code | 65473 |
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| 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.