Healthcare Provider Details

I. General information

NPI: 1568669729
Provider Name (Legal Business Name): PETER KING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 LINCOLN AVE
GLEN ROCK NJ
07452-3231
US

IV. Provider business mailing address

328 LYNN DR
FRANKLIN LAKES NJ
07417-2325
US

V. Phone/Fax

Practice location:
  • Phone: 201-857-2661
  • Fax: 201-857-2599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDI20062
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: