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DR. PARK DENTAL OFFICE 1, LLC
NPI 1508594664
Dentist - General Practice in Saint Paul, MN

Active since August 08, 2022
1550 WHITE BEAR AVE N, SAINT PAUL, MN 55106(651) 788-7045 Get Directions Write a Review

NPPES record last updated: August 8, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Park Dental Office 1, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. PARK DENTAL OFFICE 1, LLC (NPI 1508594664), doing business as Clear Lakes Dental, is a healthcare organization registered as a general practice in Saint Paul, Minnesota and active in the NPI registry since August 2022. The organization lists David J Park, Ceo/president/owner, as its authorized official.

NPPES Registry Identity

NPI1508594664
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameDR. PARK DENTAL OFFICE 1, LLC
Location Address1550 WHITE BEAR AVE NSaint Paul, MN 55106-1602
Mailing Address1550 White Bear Ave NSaint Paul, MN 55106-1602 · (651) 788-7045
Phone(651) 788-7045
Organization SubpartNo
Authorized OfficialDavid J ParkCeo/president/owner · (651) 444-9644
Enumeration DateAugust 8, 2022
NPPES CertifiedAugust 8, 2022
✔ NPI 1508594664 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
1550 WHITE BEAR AVE N, Saint Paul, MN 55106
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Other Names 1

Doing Business AsClear Lakes Dental

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAXWELL UGOCHUKWU OGUMGBUAJA
Dentist (General Practice)
1550 WHITE BEAR AVE N
SAINT PAUL, MN 55106
Ramsey County (651) 788-7045

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dr. Park Dental Office 1, LLC's NPI number?

The NPI number for Dr. Park Dental Office 1, LLC is 1508594664. It was assigned to this organization in the NPPES registry on August 8, 2022. The provider is doing business as Clear Lakes Dental.

Where is Dr. Park Dental Office 1, LLC located?

Dr. Park Dental Office 1, LLC is located at 1550 White Bear Ave N, Saint Paul, MN 55106. The listed phone number is (651) 788-7045.

What is Dr. Park Dental Office 1, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Dr. Park Dental Office 1, LLC was last updated on August 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.