Provider Demographics
NPI:1619018009
Name:KWON, PETER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:KWON
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 1:7970 OLD GEORGETOWN RD
Mailing Address - Street 2:4-B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2447
Mailing Address - Country:US
Mailing Address - Phone:301-657-9116
Mailing Address - Fax:301-654-0480
Practice Address - Street 1:7970 OLD GEORGETOWN RD
Practice Address - Street 2:4-B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2447
Practice Address - Country:US
Practice Address - Phone:301-657-9116
Practice Address - Fax:301-654-0480
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410839122300000X
MD130181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist