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General NPI Number Information
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NPI Number | 1750828885
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Entity Type | Organization
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Legal Business Name | IRVING DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 807 N BELT LINE RD
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City | IRVING
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State | TX
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Zip | 75061-6317
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Country | US
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Telephone | 972-313-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 807 N BELT LINE RD
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City | IRVING
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State | TX
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Zip | 75061-6317
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Country | US
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Telephone | 972-313-2002
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SEHWOON KIM
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Credential | DMD
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Telephone | 972-891-8365
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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 | 28702
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License Number State | TX
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