| Kwon Pediatric Dentistry | |
|
3590 Braselton Hwy Bldg B Ste 100 Dacula GA 30019-1117 | |
| (678) 714-7575 | |
| (678) 714-7525 |
| Full Name | Kwon Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3590 Braselton Hwy Bldg B, Dacula, Georgia |
| Authorized Official Name and Position | Renee Salmon (FINANCIAL MANAGER) |
| Authorized Official Contact | 6787147575 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kwon Pediatric Dentistry 3590 Braselton Hwy Suite 201 Dacula GA 30019-1117 Ph: (678) 714-7575 | Kwon Pediatric Dentistry 3590 Braselton Hwy Bldg B Ste 100 Dacula GA 30019-1117 Ph: (678) 714-7575 |
| NPI Number | 1538692314 |
|---|---|
| Provider Enumeration Date | 04/07/2017 |
| Last Update Date | 04/11/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538692314 | NPI | - | NPPES |
| 724916844C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
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