Provider Demographics
NPI:1417176157
Name:KIM, EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3433
Mailing Address - Country:US
Mailing Address - Phone:207-274-3167
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2617
Practice Address - Country:US
Practice Address - Phone:207-221-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0357131223G0001X
ME4101122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice