Provider Demographics
NPI:1760999726
Name:EVERBRIGHT DENTAL PLLC
Entity Type:Organization
Organization Name:EVERBRIGHT DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENETIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:936-230-5525
Mailing Address - Street 1:20212 EVA ST.
Mailing Address - Street 2:#160
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356
Mailing Address - Country:US
Mailing Address - Phone:936-230-5525
Mailing Address - Fax:
Practice Address - Street 1:20212 EVA ST.
Practice Address - Street 2:#160
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356
Practice Address - Country:US
Practice Address - Phone:936-230-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty