Provider Demographics
NPI:1275662793
Name:SHELLY KING, DMD, PA
Entity Type:Organization
Organization Name:SHELLY KING, DMD, PA
Other - Org Name:KINGS CROWN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:DALEY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-337-5464
Mailing Address - Street 1:6900 DANIELS PKWY
Mailing Address - Street 2:SUITE 30
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7513
Mailing Address - Country:US
Mailing Address - Phone:239-337-5464
Mailing Address - Fax:239-561-2742
Practice Address - Street 1:6900 DANIELS PKWY
Practice Address - Street 2:SUITE 30
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7513
Practice Address - Country:US
Practice Address - Phone:239-337-5464
Practice Address - Fax:239-561-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty