Provider Demographics
NPI:1851666903
Name:KWON DENTISTRY, LLC
Entity Type:Organization
Organization Name:KWON DENTISTRY, LLC
Other - Org Name:AESTHETIC FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-661-2828
Mailing Address - Street 1:1201 SE 223RD AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2580
Mailing Address - Country:US
Mailing Address - Phone:503-661-2828
Mailing Address - Fax:503-618-9874
Practice Address - Street 1:1201 SE 223RD AVE STE 260
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2580
Practice Address - Country:US
Practice Address - Phone:503-661-2828
Practice Address - Fax:503-618-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty