Provider Demographics
NPI:1538612346
Name:KWON, EDWARD SOONJO (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:SOONJO
Last Name:KWON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 BENTGRASS DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3927
Mailing Address - Country:US
Mailing Address - Phone:716-534-5690
Mailing Address - Fax:
Practice Address - Street 1:1493 BENTGRASS DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3927
Practice Address - Country:US
Practice Address - Phone:716-534-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice