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General NPI Number Information
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NPI Number | 1902553399
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Entity Type | Organization
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Legal Business Name | MT PLEASANT GENTLE FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 2185 E PICKARD RD STE B
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City | MOUNT PLEASANT
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State | MI
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Zip | 48858-1287
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Country | US
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Telephone | 989-772-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 2185 E PICKARD RD STE B
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City | MOUNT PLEASANT
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State | MI
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Zip | 48858-1287
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Country | US
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Telephone | 989-772-4200
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JUNG KEUN KIM
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Credential | DDS
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Telephone | 917-755-5784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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