Healthcare Provider Details

I. General information

NPI: 1407039803
Provider Name (Legal Business Name): DEBRA GRAY KING, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 ROSWELL RD NE
ATLANTA GA
30342
US

IV. Provider business mailing address

5014 ROSWELL RD NE
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-847-9711
  • Fax: 404-303-8867
Mailing address:
  • Phone: 404-847-9711
  • Fax: 404-303-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN010442
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN012440
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10490
License Number StateGA

VIII. Authorized Official

Name: DR. DEBRA G KING
Title or Position: OWNER
Credential:
Phone: 404-847-9711