Provider Demographics
NPI:1295846293
Name:KIM, TOMMY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:L
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10220 PROSPERITY PARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1105
Mailing Address - Country:US
Mailing Address - Phone:707-948-5684
Mailing Address - Fax:704-948-5686
Practice Address - Street 1:10220 PROSPERITY PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1105
Practice Address - Country:US
Practice Address - Phone:707-948-5684
Practice Address - Fax:704-948-5686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice