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General NPI Number Information
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NPI Number | 1679048292
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Entity Type | Organization
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Legal Business Name | NAVO DENTAL PROFESSIONALS PC
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 26742 E. UNIVERSITY DR. BUILDING 200, SUITE 220
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City | AUBREY
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State | TX
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Zip | 76227
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Country | US
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Telephone | 972-845-1234
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Fax | 972-845-1212
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Provider Business Mailing Address
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Address Line | 15517 BRYANT PARK AVE
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City | PROSPER
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State | TX
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Zip | 75078-1711
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Country | US
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Telephone | 682-308-4015
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Fax | 972-845-1212
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KELLY HEEJUNG KIM
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Credential | DDS
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Telephone | 682-308-4015
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #4
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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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