Provider Demographics
NPI:1194845222
Name:KING, MICHAEL A (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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 1:4255 ALTAMONT PL STE 302
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3082
Mailing Address - Country:US
Mailing Address - Phone:615-293-6519
Mailing Address - Fax:
Practice Address - Street 1:4255 ALTAMONT PL STE 302
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3082
Practice Address - Country:US
Practice Address - Phone:301-645-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142031223S0112X
GADN0127071223S0112X
DCDEN10006561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028778400Medicaid
MD028778401Medicaid
DC039757600Medicaid
1003178963OtherTYPE 2 NPI