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General NPI Number Information
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NPI Number | 1528169174
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Entity Type | Organization
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Legal Business Name | LISA KING DDS MS PA
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8300 CARMEL AVE NE SUITE 403
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3147
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Country | US
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Telephone | 505-266-7678
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Fax | 505-299-7070
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Provider Business Mailing Address
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Address Line | 8300 CARMEL AVE NE SUITE 403
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3147
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Country | US
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Telephone | 505-266-7678
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Fax | 505-299-7070
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. LISA KING
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Credential | DDS MS
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Telephone | 505-299-7678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1752
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License Number State | NM
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