Basic Information
| Provider Information | |||||||||
| NPI: | 1790455459 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KING PEDIATRIC DENTISTRY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1695 N PARK DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333263294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544510265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1695 N PARK DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333263294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544510265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2021 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DMD | ||||||||
| AuthorizedOfficialTelephone: | 9544510265 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.