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General NPI Number Information
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NPI Number | 1972982320
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Entity Type | Organization
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Legal Business Name | PETER KWON, DDS, LLC
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 7970 OLD GEORGETOWN RD 4-B
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City | BETHESDA
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State | MD
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Zip | 20814-2447
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Country | US
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Telephone | 301-657-9116
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Fax | 301-654-0480
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Provider Business Mailing Address
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Address Line | 7970-B OLD GEORGETOWN RD.
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone | 301-657-9116
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Fax | 301-654-0480
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PETER KWON
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Credential | D.D.S.
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Telephone | 301-657-9116
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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 | 13018
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License Number State | MD
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