Provider Demographics
NPI:1003002361
Name:KING, MICHAEL ENON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ENON
Last Name:KING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16689 RIVER RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4630
Mailing Address - Country:US
Mailing Address - Phone:703-221-9759
Mailing Address - Fax:703-221-2788
Practice Address - Street 1:16689 RIVER RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4630
Practice Address - Country:US
Practice Address - Phone:703-221-9759
Practice Address - Fax:703-221-2788
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010085931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice