Provider Demographics
NPI:1972568020
Name:DRINKWATER, JOSEPH KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KIM
Last Name:DRINKWATER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHONG
Other - Middle Name:WON
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3202 S W S YOUNG DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6538
Mailing Address - Country:US
Mailing Address - Phone:254-519-2875
Mailing Address - Fax:808-433-1558
Practice Address - Street 1:3202 S W S YOUNG DR STE 101
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6538
Practice Address - Country:US
Practice Address - Phone:254-519-2875
Practice Address - Fax:254-519-2877
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376521223G0001X
TX225511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN