SO EUN PARK (NPI# 1871071621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871071621 |
| Entity Type | Individual |
| Full Name | SO EUN PARK |
| Credential | DDS |
| Practice Address |
3301 W Kimberly Rd Ste 5 Davenport IA 52806-3047 |
| Mailing Address |
2050 E Algonquin Rd Ste 610 Schaumburg IL 60173-4166 |
| Practice Telephone | 8889884066 |
| Practice Fax Number | 8474964850 |
| Mailing Telephone | 8889884066 |
| Mailing Fax Number | 8474964850 |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2020-06-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 019.032300 | IL | Dental Providers |
| Y | 122300000X | Dentist | 09596 | IA | Dental Providers |
| Street Address |
3301 W KIMBERLY RD STE 5 |
| City | DAVENPORT |
| State | IA |
| Zip Code | 52806-3047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205287067 | Familia Dental Davenport LLC | Dentist | 3301 W Kimberly Rd Ste 5, Davenport, IA 52806-3047 | 2016-06-23 |
| 1730799677 | Rong Zheng | Dentist | 3301 W Kimberly Rd Ste 5, Davenport, IA 52806-3047 | 2020-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912543257 | June Swain | Nurse Practitioner | Quad City Family Physician, 3940 Marquette Street, Davenport, IA 52806 | 2019-11-21 |
| 1881055747 | Jace Carter | Chiropractor | 235 West 35th Street Suite 2d, Davenport, IA 52806 | 2016-03-18 |
| 1538468210 | Cody Krech | Dentist | 141 E 46th St, Davenport, IA 52806 | 2011-03-21 |
| 1619287216 | Robert Earl Clark | Occupational Therapist | 6623 N Main St, Davenport, IA 52806 | 2010-10-15 |
| 1689902579 | Nicholas P. Carlson | Nurse Practitioner | 3801 Marguette Street, Suite 200, Davenport, IA 52806 | 2009-12-03 |
| 1295821114 | David Lee Botsko | Dentist | 2334 W. Kimberly Road, Davenport, IA 52806 | 2006-10-05 |
| 1598712903 | Select Specialty Hospital - Quad Cities Inc | Long Term Care Hospital | 1111 West Kimberly Road, Davenport, IA 52806 | 2006-05-30 |
| 1528030350 | Warren Wright | Occupational Therapist | 1008 W 35th St, Davenport, IA 52806 | 2006-02-06 |
| 1144291568 | Gerald Wallace Hess | Chiropractor | 2711 W 63rd St, Ste #1, Davenport, IA 52806 | 2006-02-01 |
| 1487642286 | Virginia Armstrong | Chiropractor | 4811 N Brady St Ste 1a, Davenport, IA 52806 | 2005-10-06 |
| Find all providers in zip 52806 | ||||
| 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 |
|---|---|---|---|---|
| 1568005999 | Davenport Modern Dentistry, Pa | Dentist | 1159 Posner Blvd, Davenport, FL 33837-3664 | 2019-10-17 |
| 1740756139 | Dague Dental Solutions | Dentist | 4711 N Brady St Ste 5s, Davenport, IA 52806-3955 | 2018-10-23 |
| 1871086405 | Mateo Vidales | Dentist | 7700 Lake Wilson Rd, Davenport, FL 33896-9601 | 2018-06-08 |
| 1083105878 | Kunmin Roo | Dentist | 5025 Utica Ridge Rd Ste 103, Davenport, IA 52807-3035 | 2018-05-29 |
| 1902258379 | Secure Dental II, LLC | Dentist | 5025 Utica Ridge Rd, Suite 103, Davenport, IA 52807 | 2016-07-08 |
| 1891176160 | Annissa Michael | Dentist | 7551 Osceola Polk Line Road, Davenport, FL 33896 | 2015-06-12 |
| 1932517588 | Alan Christopher Rubach | Dentist | 3435 Spring St Ste 2, Davenport, IA 52807 | 2014-07-28 |
| 1821285776 | Brian Arthur Mykleby | Dentist | 2215 E 52nd St Ste 1, Davenport, IA 52807-2786 | 2007-09-25 |
| 1356561047 | Valerie Jennings | Dentist | 4624 Progress Drive, Suite E, Davenport, IA 52807-3490 | 2007-04-26 |
| 1245373737 | Monica Foley | Dentist | 1850 E 53rd St Ste 5, Davenport, IA 52807-2784 | 2007-02-14 |
| Find all providers in DAVENPORT | ||||
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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.