Provider Demographics
NPI:1790522324
Name:FOLSOM, SOJEONG KIM (DMD)
Entity type:Individual
Prefix:DR
First Name:SOJEONG
Middle Name:KIM
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRIT AVE WOMACK ARMY MEDICAL CANTER
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8707
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:920 W HAMLET AVE STE A
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4520
Practice Address - Country:US
Practice Address - Phone:910-582-5143
Practice Address - Fax:910-582-8620
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140521223G0001X
VT0160134275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist