MEDICARE: MADELINE 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	122300000X	Dentist	DN23358	FL

General Provider Information

NPI Number	:	1285126102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE KING DMD

Provider Business Mailing Address
First Line	:	2531 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2531 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4432
Country	:	US
Telephone Number	:	407-425-0087
Fax Number	:

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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Directions to “ MADELINE KING DMD” Practice Location

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