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NPI Code Detail

MEDICARE: DANA KIM, DMD, LLC

MEDICARE: DANA KIM, DMD, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1023517539
Entity Type Code : Organization
Provider Name (Legal Business Name) : DANA KIM, DMD, LLC
Provider Business Mailing Address
First Line : 29795 THREE NOTCH RD
Second Line :
City : CHARLOTTE HALL
State : MD
Zip : 20622-4106
Country : US
Telephone Number : 301-290-0001
Fax Number : 301-290-5633
Provider Business Practice Location Address
First Line : 29795 THREE NOTCH RD
Second Line :
City : CHARLOTTE HALL
State : MD
Zip : 20622-4106
Country : US
Telephone Number : 301-290-0001
Fax Number : 301-290-5633
Authorized Official
Title or Position : OFFICE MANAGER
Name : AUDRA KEELER
Credential :
Telephone Number : 301-290-0001
Provider Enumeration Date : 02/09/2018
Last Update Date : 02/09/2018

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Directions to “DANA KIM, DMD, LLC ” Practice Location

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