Provider Demographics
NPI:1952896102
Name:KWON, SOONHO (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOONHO
Middle Name:
Last Name:KWON
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 1:36 SCHOOL ST # 36A
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1442
Mailing Address - Country:US
Mailing Address - Phone:857-250-1903
Mailing Address - Fax:
Practice Address - Street 1:133 LITTLETON RD STE 201
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3198
Practice Address - Country:US
Practice Address - Phone:978-399-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist