MEDICARE: KING DENTAL LLC

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	1223G0001X	General Practice Dentistry	11665	MD

General Provider Information

NPI Number	:	1295803088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING DENTAL LLC

Provider Business Mailing Address
First Line	:	1400 SPRING ST
Second Line	:	SUITE 420
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2735
Country	:	US
Telephone Number	:	301-562-0811
Fax Number	:	301-562-1308

Provider Business Practice Location Address
First Line	:	1400 SPRING ST
Second Line	:	SUITE 420
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2735
Country	:	US
Telephone Number	:	301-562-0811
Fax Number	:	301-562-1308

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES HENRY KING III
Credential	:	DDS
Telephone Number	:	301-562-0811

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	12/07/2015

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