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General NPI Number Information
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NPI Number | 1295505246
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Entity Type | Organization
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Legal Business Name | KENT DENTISTRY & IMPLANTS
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 70 MAPLE ST
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City | KENT
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State | CT
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Zip | 06757-1721
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Country | US
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Telephone | 860-927-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 70 MAPLE ST
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City | KENT
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State | CT
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Zip | 06757-1721
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Country | US
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Telephone | 860-927-3577
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Fax |
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | GI TAE KWON
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Credential | DDS
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Telephone | 201-707-4661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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