Provider Demographics
NPI:1023517539
Name:DANA KIM, DMD, LLC
Entity type:Organization
Organization Name:DANA KIM, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-290-0001
Mailing Address - Street 1:29795 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-4106
Mailing Address - Country:US
Mailing Address - Phone:301-290-0001
Mailing Address - Fax:301-290-5633
Practice Address - Street 1:29795 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-4106
Practice Address - Country:US
Practice Address - Phone:301-290-0001
Practice Address - Fax:301-290-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental