Organization
SAMUEL S. KWON,DMD-IV CENTER PC
Active
Parent organization
SAMUEL S. KWON DMD PC
Other names
Kwon Pediatric Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAMUEL S. KWON DMD PC
Authorized official
RENEE SALMON (FINANCIAL MANAGER)
(678) 714-7575
Entity
Organization
Contact information
Practice address
3590 BRASELTON HWY BLDG B, STE 100, DACULA, GA 30019-1117
(678) 714-7575
(678) 714-7525
Mailing address
3590 BRASELTON HWY, SUITE 201, DACULA, GA 30019-1117
(678) 714-7575
(678) 714-7525
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
724916844C
—
GA
Enumeration date
04/07/2017
Last updated
04/11/2017
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