MEDICARE: DEBRA GRAY KING, DDS PC

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	122300000X	Dentist	DN010442	GA
2	1223P0700X	Prosthodontics	DN012440	GA
3	122300000X	Dentist	10490	GA

General Provider Information

NPI Number	:	1407039803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA GRAY KING, DDS PC

Provider Business Mailing Address
First Line	:	5014 ROSWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342
Country	:	US
Telephone Number	:	404-847-9711
Fax Number	:	404-303-8867

Provider Business Practice Location Address
First Line	:	5014 ROSWELL RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342
Country	:	US
Telephone Number	:	404-847-9711
Fax Number	:	404-303-8867

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEBRA G KING
Credential	:
Telephone Number	:	404-847-9711

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	10/02/2014

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