Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1255984324 Individual Practitioner Female Practitioner

Dr. Ji Won Park , DMD

Dentist - General Practice • Marietta, GA

Professional Overview & Biography Verified Profile Summary

Dr. Ji Won Park, DMD is a registered healthcare professional specializing in Dentist - General Practice in Marietta, GA. Practice services are available at 1605 ROBERTA DR SW under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1605 Roberta Dr Sw

Marietta, GA 300083855

Telephone 7704193120
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Marietta, GA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 12.0 Yrs
State Avg: 22.8 Yrs
Regional Practice Density
162 Specialists

Practicing in Marietta, 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

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License GA DN015875

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

14 Associated Practitioners
Venetta Mwengella , NP-C

Nurse Practitioner - Family

NPI 1275015281

Nurse Practitioner (Certified)

Marjan Kirkland , FNP-C

Nurse Practitioner - Family

NPI 1326349614

Family Nurse Practitioner (Certified)

NPI 1376004259

Doctor of Osteopathic Medicine (D.O.)

NPI 1427745678

Registered Pharmacist

Laura Bayani , PA-C

Physician Assistant

NPI 1578819918

Physician Assistant (Certified)

NPI 1609160266

Doctor of Pharmacy (Pharm.D.)

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active July 18, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location July 18, 2019

Registered at 1605 ROBERTA DR SW, MARIETTA, GA 300083855 (Tel: 7704193120)

📍
Updated Business Mailing Address July 18, 2019

Registered at 11 PERIMETER CTR E APT 2304, ATLANTA, GA 303461650 (Tel: 4044284851)

👤
Provider Name / Credentials Updated July 18, 2019

Recorded as JI WON PARK, DMD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 18, 2019

Dentist (License #DN015875 in GA)

🟢
Initial NPI Registration & Enumeration July 18, 2019

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: 1255984324
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 18, 2019
Last Update: July 18, 2019
Sole Proprietor: No

Mailing Address

11 Perimeter Ctr E Apt 2304

Atlanta, GA 303461650

Phone: 4044284851

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.