Active NPI
Prime Dental, L.L.C.
- General Practice Dentistry
- Albuquerque, NM
National Provider Identifier
1962711705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DD3398
- Legal business name
- PRIME DENTAL, L.L.C.
- Practice address
- 8611 Golf Course Rd NW
Albuquerque, NM 87114-5775 - Phone
- (505) 891-6101
- NPI assigned
- Sep 28, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sun Chun Kim, DDS
- Title
- President
- Phone
- (404) 610-6816
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD3398 | NM | Primary |
| General Practice Dentistry | 1223G0001X | DN013943 | GA |
Addresses
Primary practice location
8611 Golf Course Rd NW
Albuquerque, NM 87114-5775
Mailing address
8611 Golf Course Rd NW
Albuquerque, NM 87114-5775
Phone (505) 891-6101
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD3398 | Other | NM | NEW MEXICO BOARD OF DENTAL CARE |
| DN013943 | Other | GA | GEORGIA BOARD OF DENTISTRY |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1285632000000",
"number": "1962711705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8611 GOLF COURSE RD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871145775",
"telephone_number": "505-891-6101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8611 GOLF COURSE RD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871145775",
"telephone_number": "505-891-6101"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRIME DENTAL, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-28",
"last_updated": "2010-09-28",
"status": "A",
"authorized_official_last_name": "KIM",
"authorized_official_first_name": "SUN",
"authorized_official_middle_name": "CHUN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "404-610-6816",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "NM",
"license": "DD3398",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN013943",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW MEXICO BOARD OF DENTAL CARE",
"identifier": "DD3398",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA BOARD OF DENTISTRY",
"identifier": "DN013943",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.