Provider Demographics
NPI:1619424827
Name:DULUTH DENTAL AND DENTURES LLC
Entity Type:Organization
Organization Name:DULUTH DENTAL AND DENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-924-9848
Mailing Address - Street 1:1625 PLEASANT HILL RD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2326
Mailing Address - Country:US
Mailing Address - Phone:678-924-9848
Mailing Address - Fax:
Practice Address - Street 1:1625 PLEASANT HILL RD
Practice Address - Street 2:SUITE #140
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2326
Practice Address - Country:US
Practice Address - Phone:678-924-9848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015143261QD0000X
PADS040187261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental