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Organization
KIM IERNA KITCHEN DDS, PC
Active
Organization
KIM IERNA KITCHEN DDS, PC
Active
Other names
Old Town Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM IERNA KITCHEN DDS (OWNER/DENTIST)
(703) 836-7000
Entity
Organization
Contact information
Practice address
500 MONTGOMERY ST STE 250, ALEXANDRIA, VA 22314-1558
(703) 836-7000
Mailing address
500 MONTGOMERY ST STE 250, ALEXANDRIA, VA 22314-1558
(703) 836-7000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134350853
ASSOCIATE DENTIST
—
Enumeration date
11/05/2020
Last updated
11/05/2020
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