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General NPI Number Information
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NPI Number | 1730351040
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Entity Type | Organization
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Legal Business Name | KING FAMILY DENTAL CARE, PC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 915 W HIGHLAND AVE
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City | ALBANY
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State | GA
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Zip | 31701-2735
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Country | US
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Telephone | 229-435-0677
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Fax | 229-439-0533
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Provider Business Mailing Address
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Address Line | 915 W HIGHLAND AVE
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City | ALBANY
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State | GA
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Zip | 31701-2735
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Country | US
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Telephone | 229-435-0677
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Fax | 229-439-0533
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Authorized Official
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Title or Position | CEO
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Name | DR. CHARLES KING SR.
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Credential | DMD
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Telephone | 229-435-0677
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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 | 09643
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License Number State | GA
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