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General NPI Number Information
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NPI Number | 1356083034
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Entity Type | Organization
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Legal Business Name | KING FAMILY DENTAL CARE, P.A.
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 405 HOGAN LN STE 1
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City | CONWAY
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State | AR
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Zip | 72034-8202
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Country | US
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Telephone | 501-336-0300
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Fax | 501-336-0545
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Provider Business Mailing Address
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Address Line | PO BOX 10522
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City | CONWAY
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State | AR
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Zip | 72034-0008
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Country | US
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Telephone | 501-908-3108
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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. MITCHELL DELAYNE KING
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Credential | DDS
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Telephone | 501-336-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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