| Mustard Seed Pediatric Dentistry, Llc | |
|
1120 Peachtree Industrial Blvd Suite 203 And 204 Suwanee GA 30024-2013 | |
| (770) 904-7005 | |
| (770) 904-7075 |
| Full Name | Mustard Seed Pediatric Dentistry, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1120 Peachtree Industrial Blvd, Suwanee, Georgia |
| Authorized Official Name and Position | Yoo Mee Kim (DENTIST/OWNER) |
| Authorized Official Contact | 7709047005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mustard Seed Pediatric Dentistry, Llc 1120 Peachtree Industrial Blvd Suite 203 And 204 Suwanee GA 30024-2013 Ph: (770) 904-7005 | Mustard Seed Pediatric Dentistry, Llc 1120 Peachtree Industrial Blvd Suite 203 And 204 Suwanee GA 30024-2013 Ph: (770) 904-7005 |
| NPI Number | 1093048563 |
|---|---|
| Provider Enumeration Date | 09/15/2009 |
| Last Update Date | 09/15/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093048563 | NPI | - | NPPES |
| 1255479689 | Other | GA | INDIVIDUAL NPI # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN013415 (Georgia) | Primary |
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