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General NPI Number Information
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NPI Number | 1629497912
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Entity Type | Organization
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Legal Business Name | FOREST FALLS DENTAL, PA
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 10 FOREST FALLS DR UNIT 9A
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City | YARMOUTH
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State | ME
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Zip | 04096-6936
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Country | US
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Telephone | 207-846-3966
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Fax |
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Provider Business Mailing Address
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Address Line | 10 FOREST FALLS DR UNIT 9A
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City | YARMOUTH
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State | ME
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Zip | 04096-6936
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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
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Name | EUGENE KIM
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Credential | DDS
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Telephone | 207-846-3966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4101
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License Number State | ME
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