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General NPI Number Information
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NPI Number | 1407039803
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Entity Type | Organization
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Legal Business Name | DEBRA GRAY KING, DDS PC
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 5014 ROSWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30342
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Country | US
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Telephone | 404-847-9711
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Fax | 404-303-8867
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Provider Business Mailing Address
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Address Line | 5014 ROSWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30342
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Country | US
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Telephone | 404-847-9711
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Fax | 404-303-8867
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBRA G KING
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Credential |
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Telephone | 404-847-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN010442
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN012440
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10490
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License Number State | GA
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