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General NPI Number Information
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NPI Number | 1578647251
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Entity Type | Individual
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Provider Name | MICHEL JOSEPH KING DDS
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 351 S LINCOLN ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-2706
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Country | US
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Telephone | 812-333-6440
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Fax | 812-333-1949
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Provider Business Mailing Address
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Address Line | 351 S LINCOLN ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-2706
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Country | US
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Telephone | 812-333-6440
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Fax | 812-333-1949
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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 | 12008275A
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License Number State | IN
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