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General NPI Number Information
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NPI Number | 1497919948
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Entity Type | Organization
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Legal Business Name | TRADERS POINT DENTAL
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 6010 W 86TH ST 118
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1411
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Country | US
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Telephone | 317-872-4746
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Fax | 317-663-1169
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Provider Business Mailing Address
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Address Line | 6010 W 86TH ST 118
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1411
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Country | US
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Telephone | 317-872-4746
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Fax | 317-663-1169
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANG HOYK KWON
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Credential | D.D.S.
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Telephone | 317-872-4746
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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 | 12011161A
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License Number State | IN
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