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General NPI Number Information
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NPI Number | 1972207066
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Entity Type | Organization
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Legal Business Name | OK DENTAL PLLC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 2810 E TRINITY MILLS RD STE 179
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City | CARROLLTON
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State | TX
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Zip | 75006-2351
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Country | US
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Telephone | 469-830-8831
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 MESKWAKI WAY
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City | CARROLLTON
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State | TX
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Zip | 75010-1168
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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 | MANAGAER
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Name | TAE H KIM
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Credential | DMD
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Telephone | 469-830-8831
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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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Taxonomy #2
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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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