Organization
PRIME DENTAL, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUN CHUN KIM DDS (PRESIDENT)
(404) 610-6816
Entity
Organization
Contact information
Practice address
8611 GOLF COURSE RD NW, ALBUQUERQUE, NM 87114-5775
(505) 891-6101
Mailing address
8611 GOLF COURSE RD NW, ALBUQUERQUE, NM 87114-5775
(505) 891-6101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3398
NM
1223G0001X
General Practice Dentistry
DN013943
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD3398
NEW MEXICO BOARD OF DENTAL CARE
NM
01
—
DN013943
GEORGIA BOARD OF DENTISTRY
GA
Enumeration date
09/28/2010
Last updated
09/28/2010
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