Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1366521122 Individual Practitioner Male Practitioner

Dr. Douglas Lee Park , DDS

Dentist - Pediatric Dentistry • Gresham, OR

Professional Overview & Biography Verified Profile Summary

Dr. Douglas Park, DDS is a registered healthcare professional specializing in Dentist - Pediatric Dentistry in Gresham, OR. Practice services are available at 1201 SE 223RD AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1201 Se 223rd Ave
Suite 240

Gresham, OR 97030

Telephone 5036669800
Fax 5036666787
Associated Practice Facility / Clinic
🏢 Daniel J Ries, Dmd, Pc Facility NPI 1871768853

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - Pediatric Dentistry in Gresham, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
6 Specialists

Practicing in Gresham, OR (180 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 - Pediatric Dentistry Primary Specialty

NUCC Taxonomy Code: 1223P0221X

State License OR D6620

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Practice Associates & Co-Workers

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

3 Associated Practitioners
Dr. Daniel Ries , DMD

Dentist - General Practice

NPI 1386715910

Doctor of Dental Medicine

Dr. Kevin Shim , DDS

Dentist - General Practice

NPI 1386784437

Doctor of Dental Surgery

Dr. Perry Stevenson , DDS, MS, PC

Dentist - Orthodontics and Dentofacial Orthopedics

NPI 1740384460

Doctor of Dental Surgery, Master of Science, PC

Career & Practice History Timeline

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

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 1201 SE 223RD AVE, SUITE 240, GRESHAM, OR 97030 (Tel: 5036669800)

📍
Updated Business Mailing Address July 08, 2007

Registered at 34116 SE CARPENTER LN, GRESHAM, OR 97080 (Tel: 5036635162)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as DOUGLAS PARK, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #D6620 in OR)

🟢
Initial NPI Registration & Enumeration November 03, 2006

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: 1366521122
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 03, 2006
Last Update: July 08, 2007
Sole Proprietor: No

Mailing Address

34116 Se Carpenter Ln

Gresham, OR 97080

Phone: 5036635162

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.