Organization Name: | MUSTARD SEED PEDIATRIC DENTISTRY, LLC |
NPI Number: | 1093048563 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | YOO MEE KIM (DENTIST/OWNER) |
Mailing Address: | 1120 Peachtree Industrial Blvd Suite 203 And 204 Suwanee |
State: | GA US |
Postal Code: | 300242013 |
Phone Number: | 7709047005 |
Fax Number: | 7709047075 |
NPI Enumeration Date: | 09/15/2009 |
NPI Last Update Date: | 09/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | DN013415 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |