MEDICARE: DR. CARIE C KING D.D.S

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	15707	TX

General Provider Information

NPI Number	:	1336157437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARIE C KING D.D.S

Provider Business Mailing Address
First Line	:	6300 N BEACH ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2622
Country	:	US
Telephone Number	:	817-281-3100
Fax Number	:	817-788-5984

Provider Business Practice Location Address
First Line	:	6300 N BEACH ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2622
Country	:	US
Telephone Number	:	817-281-3100
Fax Number	:	817-788-5984

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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