Healthcare Provider Details

I. General information

NPI: 1336157437
Provider Name (Legal Business Name): CARIE C KING D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N BEACH ST
HALTOM CITY TX
76137-2622
US

IV. Provider business mailing address

6300 N BEACH ST
HALTOM CITY TX
76137-2622
US

V. Phone/Fax

Practice location:
  • Phone: 817-281-3100
  • Fax: 817-788-5984
Mailing address:
  • Phone: 817-281-3100
  • Fax: 817-788-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: