Organization
MUSTARD SEED PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOO MEE KIM DDS (DENTIST/OWNER)
(770) 904-7005
Entity
Organization
Contact information
Practice address
1120 PEACHTREE INDUSTRIAL BLVD, SUITE 203 AND 204, SUWANEE, GA 30024-2013
(770) 904-7005
(770) 904-7075
Mailing address
1120 PEACHTREE INDUSTRIAL BLVD, SUITE 203 AND 204, SUWANEE, GA 30024-2013
(770) 904-7005
(770) 904-7075
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013415
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255479689
INDIVIDUAL NPI #
GA
Enumeration date
09/15/2009
Last updated
09/15/2009
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