Provider Demographics
NPI:1225357346
Name:AHN, KWANGSEOK (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:KWANGSEOK
Middle Name:
Last Name:AHN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 BAINBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0778
Mailing Address - Country:US
Mailing Address - Phone:734-747-1804
Mailing Address - Fax:
Practice Address - Street 1:3420 K AVE
Practice Address - Street 2:STE 140
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2333
Practice Address - Country:US
Practice Address - Phone:734-747-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice