Provider Demographics
NPI:1366466245
Name:KING, JOAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
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 1:1047 MARCELLA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-5648
Mailing Address - Country:US
Mailing Address - Phone:832-287-2254
Mailing Address - Fax:
Practice Address - Street 1:410 W LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1305
Practice Address - Country:US
Practice Address - Phone:281-447-7220
Practice Address - Fax:281-447-7221
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice