Healthcare Provider Details

I. General information

NPI: 1760257844
Provider Name (Legal Business Name): DR MATTHEW KING DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27521 JEFFERSON AVE
TEMECULA CA
92590-2600
US

IV. Provider business mailing address

29432 WYATT EARP WAY
WINCHESTER CA
92596-7608
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-3676
  • Fax:
Mailing address:
  • Phone: 360-567-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW MICHAEL KING
Title or Position: PRESIDENT
Credential: DDS
Phone: 360-567-5978