Provider Demographics
NPI:1548968308
Name:SALT & LIGHT DENTAL, LLC
Entity type:Organization
Organization Name:SALT & LIGHT DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-537-5142
Mailing Address - Street 1:130 WETHERBY LN
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 WETHERBY LN
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4957
Practice Address - Country:US
Practice Address - Phone:614-890-6606
Practice Address - Fax:614-394-8685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHK DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty