Provider Demographics
NPI:1285729947
Name:KWON, CRYSTAL CARPENTER (DMD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:CARPENTER
Last Name:KWON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:8120 WOODMONT AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-657-9116
Mailing Address - Fax:301-916-0500
Practice Address - Street 1:8120 WOODMONT AVE
Practice Address - Street 2:STE. 110
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-657-9116
Practice Address - Fax:301-916-0500
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice