IndividualActive
Roderick Kim, DDS, MD
NPI 1689954562 · Oral & Maxillofacial Surgery (D.M.D.) · Fort Worth, TX
Provider details
- NPI number
- 1689954562
- Entity type
- Individual
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)Allopathic & Osteopathic Physicians
- Credential
- DDS, MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 32838 (TX)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Dental Providers
Practice location
1500 S Main St Dept of
Fort Worth, TX 76104-4917
Phone: (817) 702-6936
Approximate (ZIP-level) locationGet directions
Mailing address
1500 South Main
Fort Worth, TX 76104
Registry dates
- Enumerated
- 2011-08-23
- Last updated
- 2024-06-26
- Certified
- 2024-06-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.