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General NPI Number Information
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NPI Number | 1316444664
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Entity Type | Individual
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Provider Name | SOFIA KWAK
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 2995 PRESTON RD STE 1500
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City | FRISCO
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State | TX
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Zip | 75034-0602
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Country | US
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Telephone | 972-377-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 BELLA CT
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City | CARROLLTON
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State | TX
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Zip | 75010-4328
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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 |
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Name |
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Credential |
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Telephone |
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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 | 22DI02767500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 060802
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37966
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License Number State | TX
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