Individual
ALEXANDER Y KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
36000 SHOEMAKER LANE, SUITE 1051, FORT CAVAZOS, TX 76544
(254) 287-2705
Mailing address
1212 LEANING OAK LN, GEORGETOWN, TX 78628-2544
(847) 636-7612
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D10680
OR
1223G0001X
General Practice Dentistry
Primary
14181273-9926
UT
1223G0001X
General Practice Dentistry
36616
TX
Other
Enumeration date
07/12/2017
Last updated
10/21/2024
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