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General NPI Number Information
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NPI Number | 1528121068
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Entity Type | Individual
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Provider Name | BRUCE EDWARD KING SR. DDS
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 3791 S CENTINELA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 310-391-0699
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Fax | 310-391-6990
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Provider Business Mailing Address
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Address Line | 3791 S CENTINELA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 310-391-0699
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Fax | 310-391-6990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | B39027
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License Number State | CA
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