Provider Demographics
NPI:1346579968
Name:KING, THOMAS UPSITUR III (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:UPSITUR
Last Name:KING
Suffix:III
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 1:1725 W. ERIE AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3544
Mailing Address - Country:US
Mailing Address - Phone:215-226-1188
Mailing Address - Fax:215-226-6909
Practice Address - Street 1:1725 W. ERIE AVE.
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19140-3544
Practice Address - Country:US
Practice Address - Phone:215-226-1188
Practice Address - Fax:215-226-6909
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014278-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice