Provider Demographics
NPI:1174928519
Name:KING, DEBRA G (DDS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:G
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2207
Mailing Address - Country:US
Mailing Address - Phone:404-847-9711
Mailing Address - Fax:404-303-8867
Practice Address - Street 1:5014 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2207
Practice Address - Country:US
Practice Address - Phone:404-847-9711
Practice Address - Fax:404-303-8867
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10490122300000X
CA50713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist