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General NPI Number Information
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NPI Number | 1275292286
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Entity Type | Organization
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Legal Business Name | DELRAY PROSTHODONTICS CENTER
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 02/06/2022
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Provider Practice Location Address
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Address Line | 3116 MOUNT VERNON AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22305-2639
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Country | US
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Telephone | 703-745-5496
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 MOUNT VERNON AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22305-2639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOONGSEO KIM
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Credential | D.D.S
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Telephone | 703-587-4865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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