Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1326831595 Individual Practitioner Male Practitioner

Soon Sean Park

Dentist - General Practice • Macon, GA

Professional Overview & Biography Verified Profile Summary

Soon Park is a registered healthcare professional specializing in Dentist - General Practice in Macon, GA. Practice services are available at 4366 LOG CABIN DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4366 Log Cabin Dr

Macon, GA 312045604

Telephone 4784716060
Associated Practice Facility / Clinic
🏢 Dr Sidney Holcomb Facility NPI 1275797771

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Macon, GA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 45.0 Yrs
State Avg: 22.8 Yrs
Regional Practice Density
65 Specialists

Practicing in Macon, GA (3302 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-10-27
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License GA 123888

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. Charles Lewis , DDS

Dentist - General Practice

NPI 1437216124

Doctor of Dental Surgery

Dr. Sidney Holcomb , DDS

Dentist - General Practice

NPI 1487711263

Doctor of Dental Surgery

Maggie Zhu , RDH

Dental Hygienist

NPI 1710856760

Registered Dental Hygienist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 27, 2025

Dentist (License #123888 in GA)

NPI Profile Active May 28, 2025

NPI status registered as active in NPPES database

📍
Updated Practice Location May 28, 2025

Registered at 4366 LOG CABIN DR, MACON, GA 312045604 (Tel: 4784716060)

📍
Updated Business Mailing Address May 28, 2025

Registered at 4366 LOG CABIN DR, MACON, GA 312045604

👤
Provider Name / Credentials Updated May 28, 2025

Recorded as SOON PARK

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 28, 2025

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration May 28, 2025

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1326831595
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 28, 2025
Last Update: October 27, 2025
Sole Proprietor: No

Mailing Address

4366 Log Cabin Dr

Macon, GA 312045604

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.