Provider Demographics
NPI:1972982320
Name:PETER KWON, DDS, LLC
Entity Type:Organization
Organization Name:PETER KWON, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-657-9116
Mailing Address - Street 1:7970-B OLD GEORGETOWN RD.
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-657-9116
Mailing Address - Fax:301-654-0480
Practice Address - Street 1:7970 OLD GEORGETOWN RD
Practice Address - Street 2:4-B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2447
Practice Address - Country:US
Practice Address - Phone:301-657-9116
Practice Address - Fax:301-654-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty