MEDICARE: DR. MICHAEL WAYNE 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	6915	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1932105731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WAYNE KING D.D.S.

Provider Business Mailing Address
First Line	:	2000 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3575
Country	:	US
Telephone Number	:	731-668-2354
Fax Number	:	731-668-2243

Provider Business Practice Location Address
First Line	:	2000 GREYSTONE PARK
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3575
Country	:	US
Telephone Number	:	731-668-2354
Fax Number	:	731-668-2243

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/05/2015

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