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General NPI Number Information
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NPI Number | 1083092662
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Entity Type | Organization
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Legal Business Name | DESIGNED BY D
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 8075 FM 423 BLDG 3 SUITE 110
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City | FRISCO
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State | TX
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Zip | 75034
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Country | US
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Telephone | 646-306-5382
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 SIGMA RD 9407
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City | FARMERS BRANCH
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State | TX
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Zip | 75244-8115
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Country | US
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Telephone | 646-306-5382
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEMIAN JUNGMOOK KIM
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Credential | D.D.S
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Telephone | 646-306-5382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27612
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License Number State | TX
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