MEDICARE: KMP DENTAL PLLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1366321432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMP DENTAL PLLC

Provider Business Mailing Address
First Line	:	322 ROBLEDO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6400
Country	:	US
Telephone Number	:	781-325-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	7795 S RAINBOW BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6547
Country	:	US
Telephone Number	:	781-325-5634
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	KWANG MIN PARK
Credential	:	DMD
Telephone Number	:	781-325-5634

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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Directions to “KMP DENTAL PLLC ” Practice Location

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