Provider Demographics
NPI:1043364664
Name:KING, KATHERINE LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N CENTRAL AVE
Mailing Address - Street 2:P.O. BOX 73
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1348
Mailing Address - Country:US
Mailing Address - Phone:606-679-1402
Mailing Address - Fax:606-679-3761
Practice Address - Street 1:110 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1348
Practice Address - Country:US
Practice Address - Phone:606-679-1402
Practice Address - Fax:606-679-3761
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice