Provider Demographics
NPI:1083092662
Name:DESIGNED BY D
Entity Type:Organization
Organization Name:DESIGNED BY D
Other - Org Name:FOREST DENTAL CAFE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEMIAN
Authorized Official - Middle Name:JUNGMOOK
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-306-5382
Mailing Address - Street 1:4000 SIGMA RD
Mailing Address - Street 2:9407
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8115
Mailing Address - Country:US
Mailing Address - Phone:646-306-5382
Mailing Address - Fax:
Practice Address - Street 1:8075 FM 423 BLDG 3
Practice Address - Street 2:SUITE 110
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:646-306-5382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty