MEDICARE: DR. CHRISTOPHER TODD 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	122300000X	Dentist	0401008094	VA
2	122300000X	Dentist	VA8094	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601500	OTHER	VA	UPIN

General Provider Information

NPI Number	:	1548333271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER TODD KING DDS

Provider Business Mailing Address
First Line	:	4605 HAYGOOD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455
Country	:	US
Telephone Number	:	757-464-6228
Fax Number	:	757-363-2302

Provider Business Practice Location Address
First Line	:	4605 HAYGOOD RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5429
Country	:	US
Telephone Number	:	757-464-6228
Fax Number	:	757-363-2302

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/21/2022

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