# PRIME DENTAL, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962711705
- **Authorized official:** SUN CHUN KIM DDS (PRESIDENT)
- **Authorized official phone:** (404) 610-6816

## Contact information

- **Practice address:** 8611 GOLF COURSE RD NW, ALBUQUERQUE, NM 87114-5775
- **Practice address phone:** (505) 891-6101
- **Mailing address:** 8611 GOLF COURSE RD NW, ALBUQUERQUE, NM 87114-5775
- **Mailing address phone:** (505) 891-6101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD3398 | NM | Yes |
| 1223G0001X | General Practice Dentistry | DN013943 | GA | — |

## Other

- **Enumeration date:** 09/28/2010
- **Last updated:** 09/28/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DD3398 | NEW MEXICO BOARD OF DENTAL CARE | NM |
| 01 | — | DN013943 | GEORGIA BOARD OF DENTISTRY | GA |