Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Etern S Park, DDS, MD

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1124289905

Etern S Park, DDS, MD is an Oral Surgery in Fargo, North Dakota. Qualified in 2008, 18 years ago. Practices with Sanford Medical Center Fargo, a 1,212-clinician group and accepts Medicare assignment. Licensed in Delaware, North Dakota and New York.

Years since qualifying
18
Licensed in
DE, ND, NY
In the registry since
2008
Specialties on file
6
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1717 University Dr S
Fargo, ND 58103-4939
Phone: (701) 234-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 053210 (NY)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X · Licence 2503 (ND)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X · Licence C1-0011804 (DE)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X · Licence G3-0000458 (DE)
Oral & Maxillofacial Surgery (D.M.D.) Taxonomy 204E00000X · Licence 21037 (ND)
Oral & Maxillofacial Surgery (D.M.D.) Taxonomy 204E00000X · Licence 269333 (NY)

Record details

NPI number1124289905
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS , MD
Sole proprietorNo
NPI enumeratedJune 24, 2008
Last updated in NPPESFebruary 11, 2025
Certification dateFebruary 11, 2025
Mailing addressPo Box 5074, Sioux Falls, SD 57117-5074

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORAL SURGERY
Also practisesDENTIST, MAXILLOFACIAL SURGERY
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Sanford Medical Center Fargo — 1212 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Fargo