Organization
MODERN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCHELL KIM D.D.S. (PRESIDENT)
(972) 578-6633
Entity
Organization
Contact information
Practice address
3610 SHIRE BLVD, SUITE 204, RICHARDSON, TX 75082-2241
(972) 578-6633
Mailing address
3610 SHIRE BLVD, SUITE 204, RICHARDSON, TX 75082-2241
(972) 578-6633
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22246
TX
Other
Enumeration date
08/04/2010
Last updated
08/04/2010
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