MEDICARE: DR. BRYANT RAY KING DMD

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	DN16374	FL

General Provider Information

NPI Number	:	1851543532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYANT RAY KING DMD

Provider Business Mailing Address
First Line	:	6900 DANIELS PKWY STE 30
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1587
Country	:	US
Telephone Number	:	239-337-5464
Fax Number	:	239-561-2742

Provider Business Practice Location Address
First Line	:	6900 DANIELS PKWY STE 30
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1587
Country	:	US
Telephone Number	:	239-337-5464
Fax Number	:	239-561-2742

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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