Healthcare Provider Details

I. General information

NPI: 1669541231
Provider Name (Legal Business Name): BRETT KING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

1100 FLORIDA AVE. LSU HEALTH SCIENCES CENTER DEPT OF OMFS, BOX 220
NEW ORLEANS LA
70119
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9857
  • Fax: 504-894-5563
Mailing address:
  • Phone: 504-941-8216
  • Fax: 504-941-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberP-153
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberP-153
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: