Organization
GLORIA KIDZ DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAE WAN KIM DDS (MEMBER)
(410) 969-9090
Entity
Organization
Contact information
Practice address
7951 CRAIN HWY S, GLEN BURNIE, MD 21061-4934
(410) 969-9090
(410) 969-9055
Mailing address
7951 CRAIN HWY S, GLEN BURNIE, MD 21061-4934
(410) 969-9090
(410) 969-9055
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14267
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024168700
—
MD
Enumeration date
07/15/2010
Last updated
11/14/2014
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