Healthcare Provider Details

I. General information

NPI: 1265466163
Provider Name (Legal Business Name): WAYNE L KING DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 NORTHSIDE DR
NORTH CHARLESTON SC
29420-4209
US

IV. Provider business mailing address

7465 NORTHSIDE DR
NORTH CHARLESTON SC
29420-4209
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5400
  • Fax: 843-797-5164
Mailing address:
  • Phone: 843-797-5400
  • Fax: 843-797-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-1696
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: