Provider Demographics
NPI:1003990805
Name:KING, JAMES F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IN
Mailing Address - Zip Code:47446-0158
Mailing Address - Country:US
Mailing Address - Phone:812-849-2838
Mailing Address - Fax:812-849-3147
Practice Address - Street 1:1011 W WARREN ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446-1338
Practice Address - Country:US
Practice Address - Phone:812-849-2838
Practice Address - Fax:812-849-3147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice