Greenville Family Dentistry PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21422 Issued in TX

Legal business name

GREENVILLE FAMILY DENTISTRY PLLC

Doing business as

Krest Dental

Practice address

5006 Wesley St.
Greenville, TX 75402-6307

Phone

(903) 454-1121

Fax

(903) 454-2515

NPI assigned

Dec 2, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Soo Bin Kim, DDS

Title

Owner/ Dentist

Phone

(404) 354-6787

Specialties & licenses 1

Addresses

Other names 1

• KREST DENTAL Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1740611771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 543248",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750543248",
            "telephone_number": "903-454-1121",
            "fax_number": "903-454-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5006 WESLEY ST.",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754026307",
            "telephone_number": "903-454-1121",
            "fax_number": "903-454-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE FAMILY DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-02",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SOO",
        "authorized_official_middle_name": "BIN",
        "authorized_official_title_or_position": "OWNER/ DENTIST",
        "authorized_official_telephone_number": "404-354-6787",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KREST DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Greenville, TX
• Providers in Greenville, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.