Provider Demographics
NPI:1578917274
Name:HODONG KWON DDS PA
Entity Type:Organization
Organization Name:HODONG KWON DDS PA
Other - Org Name:KWON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HODONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-235-0280
Mailing Address - Street 1:11722 MARSH LN
Mailing Address - Street 2:#364
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2600
Mailing Address - Country:US
Mailing Address - Phone:214-350-8608
Mailing Address - Fax:214-350-0018
Practice Address - Street 1:11722 MARSH LN
Practice Address - Street 2:#364
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-2600
Practice Address - Country:US
Practice Address - Phone:214-350-8608
Practice Address - Fax:214-350-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty