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General NPI Number Information
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NPI Number | 1528773538
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Entity Type | Organization
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Legal Business Name | GLOWING SMILES PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 1019 BEATY BLVD STE 600
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City | GALLATIN
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State | TN
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Zip | 37066-4765
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Country | US
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Telephone | 615-989-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 375 BIG CREEK LN
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City | RINGGOLD
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State | GA
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Zip | 30736-8562
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Country | US
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Telephone | 423-400-8923
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. BORA KIM
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Credential | DMD
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Telephone | 423-400-8923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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