| Prime Dental Group, Llc | |
|
302 Washington Ave S Kent WA 98032-5713 | |
| (253) 520-3866 | |
| (253) 520-3844 |
| Full Name | Prime Dental Group, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 302 Washington Ave S, Kent, Washington |
| Authorized Official Name and Position | Yongjae Kim (MEMBER) |
| Authorized Official Contact | 4254573638 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Dental Group, Llc Po Box 4086 Bellevue WA 98009-4086 Ph: () - | Prime Dental Group, Llc 302 Washington Ave S Kent WA 98032-5713 Ph: (253) 520-3866 |
| NPI Number | 1407097850 |
|---|---|
| Provider Enumeration Date | 03/16/2009 |
| Last Update Date | 10/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407097850 | NPI | - | NPPES |
| 5059373 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00011116 (Washington) | Primary |
| 1223G0001X | Dentist - General Practice | DE00011115 (Washington) | Secondary |
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