Provider Demographics
NPI:1851379986
Name:NAM, SANGWOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANGWOO
Middle Name:
Last Name:NAM
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 1:4195 PLEASANT HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6385
Mailing Address - Country:US
Mailing Address - Phone:770-845-4110
Mailing Address - Fax:
Practice Address - Street 1:4195 PLEASANT HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6385
Practice Address - Country:US
Practice Address - Phone:770-845-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA501110124AMedicaid