Provider Demographics
NPI:1992987218
Name:PYON, KWANG R (DMD)
Entity type:Individual
Prefix:DR
First Name:KWANG
Middle Name:R
Last Name:PYON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4108 HAMILTON MILL RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3914
Mailing Address - Country:US
Mailing Address - Phone:470-466-2888
Mailing Address - Fax:470-466-2889
Practice Address - Street 1:4108 HAMILTON MILL RD STE 220
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3914
Practice Address - Country:US
Practice Address - Phone:470-466-2888
Practice Address - Fax:407-466-2889
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0136501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2643971OtherUNITED CONCORDIA
GA003111980Medicaid