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General NPI Number Information
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NPI Number | 1841432952
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Entity Type | Organization
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Legal Business Name | KING ORTHODONTICS, LTD
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 125 28TH ST NE SUITE 1
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City | OWATONNA
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State | MN
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Zip | 55060-2480
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Country | US
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Telephone | 507-446-9000
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Fax | 507-446-9005
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Provider Business Mailing Address
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Address Line | 1575 20TH ST NW SUITE 202
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City | FARIBAULT
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State | MN
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Zip | 55021-2930
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Country | US
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Telephone | 507-332-0022
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Fax | 507-333-9553
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. DARRIN LEE KING
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Credential | DDS
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Telephone | 507-446-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11171
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License Number State | MN
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