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NPI Code Detail

MEDICARE: AC KING DENTAL PLLC

MEDICARE: AC KING DENTAL PLLC
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
11223G0001XGeneral Practice Dentistry31167TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21124402300OTHERTXNPI

General Provider Information

NPI Number : 1366921231
Entity Type Code : Organization
Provider Name (Legal Business Name) : AC KING DENTAL PLLC
Provider Business Mailing Address
First Line : 565 W OATES RD STE 150
Second Line :
City : GARLAND
State : TX
Zip : 75043-5462
Country : US
Telephone Number : 214-473-5696
Fax Number : 214-602-5491
Provider Business Practice Location Address
First Line : 13309 MONTFORT DR
Second Line :
City : DALLAS
State : TX
Zip : 75240-5116
Country : US
Telephone Number : 214-473-5696
Fax Number : 214-602-5491
Authorized Official
Title or Position : DR
Name : SARA FALLAHI
Credential : DMD
Telephone Number : 214-473-5696
Provider Enumeration Date : 08/10/2018
Last Update Date : 01/25/2019

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Directions to “AC KING DENTAL PLLC ” Practice Location

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