Provider Demographics
NPI:1881068716
Name:KIM, ALEX (DMD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 CITYPLACE WEST BLVD APT 503
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-0360
Mailing Address - Country:US
Mailing Address - Phone:972-357-4755
Mailing Address - Fax:
Practice Address - Street 1:8222 DOUGLAS AVE STE 930
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5981
Practice Address - Country:US
Practice Address - Phone:214-369-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21615122300000X
TX35739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist