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General NPI Number Information
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NPI Number | 1548968308
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Entity Type | Organization
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Legal Business Name | SALT & LIGHT DENTAL, LLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 130 WETHERBY LN
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City | WESTERVILLE
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State | OH
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Zip | 43081-4957
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Country | US
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Telephone | 614-890-6606
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Fax | 614-394-8685
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Provider Business Mailing Address
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Address Line | 130 WETHERBY LN
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City | WESTERVILLE
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State | OH
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Zip | 43081-4957
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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 | OWNER DENTIST
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Name | SEUNG KIM
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Credential |
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Telephone | 614-537-5142
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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 |
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License Number State |
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