Provider Demographics
NPI:1942680061
Name:MJK DDS PC
Entity Type:Organization
Organization Name:MJK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-820-1457
Mailing Address - Street 1:1800 BRINKER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6176
Mailing Address - Country:US
Mailing Address - Phone:940-483-1599
Mailing Address - Fax:940-483-1597
Practice Address - Street 1:1800 BRINKER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6176
Practice Address - Country:US
Practice Address - Phone:940-483-1599
Practice Address - Fax:940-483-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty