Provider Demographics
NPI:1356083034
Name:KING FAMILY DENTAL CARE, P.A.
Entity Type:Organization
Organization Name:KING FAMILY DENTAL CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:DELAYNE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-336-0300
Mailing Address - Street 1:PO BOX 10522
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0008
Mailing Address - Country:US
Mailing Address - Phone:501-908-3108
Mailing Address - Fax:
Practice Address - Street 1:405 HOGAN LN STE 1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8202
Practice Address - Country:US
Practice Address - Phone:501-336-0300
Practice Address - Fax:501-336-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty