MEDICARE: DR. TIMOTHY MARK KING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	23939	TX

General Provider Information

NPI Number	:	1033131362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MARK KING DDS

Provider Business Mailing Address
First Line	:	17700 N US HIGHWAY 281
Second Line	:	SUITE 320
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1404
Country	:	US
Telephone Number	:	210-495-6255
Fax Number	:	210-495-6260

Provider Business Practice Location Address
First Line	:	17700 N US HIGHWAY 281
Second Line	:	SUITE 320
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1404
Country	:	US
Telephone Number	:	210-495-6255
Fax Number	:	210-495-6260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/22/2011

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Directions to “ DR. TIMOTHY MARK KING DDS” Practice Location

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