Provider Demographics
NPI:1356833479
Name:KING, CAESIE RAE (DDS)
Entity Type:Individual
Prefix:
First Name:CAESIE
Middle Name:RAE
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 1:1662 DERBYSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4497
Mailing Address - Country:US
Mailing Address - Phone:719-220-0855
Mailing Address - Fax:
Practice Address - Street 1:950 BAPTIST RD STE 100
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7711
Practice Address - Country:US
Practice Address - Phone:719-481-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002035881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice