MEDICARE: WAYNE L KING DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	30-1696	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265466163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE L KING DMD

Provider Business Mailing Address
First Line	:	7465 NORTHSIDE DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-4209
Country	:	US
Telephone Number	:	843-797-5400
Fax Number	:	843-797-5164

Provider Business Practice Location Address
First Line	:	7465 NORTHSIDE DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-4209
Country	:	US
Telephone Number	:	843-797-5400
Fax Number	:	843-797-5164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/07/2023

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