# SOUTHWESTERN PERIO & IMPLANT, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Edelweiss Dental Implant Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801242995
- **Authorized official:** JAEBUM LEE DDS (OWNER)
- **Authorized official phone:** (972) 315-2345

## Contact information

- **Practice address:** 697 E STATE HIGHWAY 121 STE 100, COPPELL, TX 75019-7950
- **Practice address phone:** (972) 315-2345
- **Mailing address:** 697 E STATE HIGHWAY 121 STE 100, COPPELL, TX 75019-7950
- **Mailing address phone:** (972) 315-2345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 29604 | TX | Yes |

## Other

- **Enumeration date:** 05/09/2016
- **Last updated:** 05/09/2016