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General NPI Number Information
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NPI Number | 1407214570
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Entity Type | Organization
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Legal Business Name | PEARBRITE DENTAL INC.
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 301 MAPLE AVE W STE 610
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City | VIENNA
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State | VA
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Zip | 22180-4300
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Country | US
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Telephone | 703-587-4865
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MAPLE AVE W STE 610
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City | VIENNA
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State | VA
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Zip | 22180-4300
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Country | US
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Telephone | 703-587-4865
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Fax |
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. JOONGSEO KIM
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Credential |
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Telephone | 703-281-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401413569
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 12296
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0401008847
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License Number State | VA
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