Provider Demographics
NPI:1003178963
Name:MICHAEL A KING DDS LLC
Entity Type:Organization
Organization Name:MICHAEL A KING DDS LLC
Other - Org Name:KING ORAL SURGERY GROUP AT CAMP SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-645-4555
Mailing Address - Street 1:6368 COVENTRY WAY
Mailing Address - Street 2:SUITE 197
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2256
Mailing Address - Country:US
Mailing Address - Phone:301-645-4555
Mailing Address - Fax:301-645-1219
Practice Address - Street 1:5801 ALLENTOWN RD
Practice Address - Street 2:SUITE 408
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4563
Practice Address - Country:US
Practice Address - Phone:301-645-4555
Practice Address - Fax:301-645-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCT86725Medicare UPIN