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General NPI Number Information
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NPI Number | 1316505720
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Entity Type | Organization
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Legal Business Name | KING ORAL SURGERY ASSOCIATES LLC
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 4255 ALTAMONT PL STE 302
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City | WHITE PLAINS
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State | MD
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Zip | 20695-3082
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Country | US
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Telephone | 301-645-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 4255 ALTAMONT PL STE 302
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City | WHITE PLAINS
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State | MD
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Zip | 20695-3082
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Country | US
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Telephone | 301-645-4555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL KING
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Credential | DDS
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Telephone | 615-293-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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