MEDICARE: DR. KEVIN 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		IL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		IL

General Provider Information

NPI Number	:	1417034521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN KING DMD

Provider Business Mailing Address
First Line	:	1010 N GILBERT ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 N GILBERT ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3849
Country	:	US
Telephone Number	:	217-442-4878
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. KEVIN KING DMD” Practice Location

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