Odelia Eunhae Kim, DDS
Individual provider Active NPI Dentist · Mabank, TX
NPI 1225762172 · NPPES record last updated Jul 14, 2022
Key facts
- NPI
- 1225762172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 38739 (TX)
- Practice address
- 507 N 3Rd St
Mabank, TX 75147-8328 - Phone
- (903) 829-4664
- NPI assigned
- Jul 14, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38739 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magnolia Dental GPS PLLC | Current |
Accepting new patients |
Locations
507 N 3rd St
Mabank, TX 75147
Phone (903) 603-4406
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 38739 | TX | Yes |
Addresses
Primary practice location
507 N 3Rd St
Mabank, TX 75147-8328
Mailing address
507 N 3Rd St
Mabank, TX 75147-8328
Other providers in Mabank, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.