Provider Demographics
NPI:1407214570
Name:PEARBRITE DENTAL INC.
Entity Type:Organization
Organization Name:PEARBRITE DENTAL INC.
Other - Org Name:PEARLBRITE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOONGSEO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-281-7011
Mailing Address - Street 1:301 MAPLE AVE W STE 610
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4300
Mailing Address - Country:US
Mailing Address - Phone:703-587-4865
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE W STE 610
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4300
Practice Address - Country:US
Practice Address - Phone:703-587-4865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014135691223E0200X
VA04010088471223P0700X
MD122961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty