| NPI | 1255695243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAEHEON KANG Periodontis 954-536-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401-413327) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2012-06-25 |