Healthcare Provider Details

I. General information

NPI: 1861303141
Provider Name (Legal Business Name): CARLY LEE KING DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 STRAWBERRY AVE
LEWISTON ME
04240-5961
US

IV. Provider business mailing address

60 OAK ST
MECHANIC FALLS ME
04256-6326
US

V. Phone/Fax

Practice location:
  • Phone: 278-206-7007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN5414
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: