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General NPI Number Information
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NPI Number | 1700920113
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Entity Type | Individual
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Provider Name | ORDIE H. KING JR. D.D.S., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6111 VOLLMER LN
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City | GODFREY
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State | IL
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Zip | 62035-1062
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Country | US
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Telephone | 618-466-3645
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Fax | 618-466-3410
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Provider Business Mailing Address
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Address Line | PO BOX 1166
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City | ALTON
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State | IL
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Zip | 62002-1166
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Country | US
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Telephone | 618-466-3645
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Fax | 618-466-3410
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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 | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State | IL
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