Provider Demographics
NPI:1457752172
Name:KIM, JOSHUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 PLEASANT HILL RD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2326
Mailing Address - Country:US
Mailing Address - Phone:615-481-7123
Mailing Address - Fax:
Practice Address - Street 1:1625 PLEASANT HILL RD
Practice Address - Street 2:SUITE #140
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2326
Practice Address - Country:US
Practice Address - Phone:615-481-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040187122300000X
GADN015143.122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist