Provider Demographics
NPI:1417083627
Name:KING, DAVID A (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N BROOM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4266
Mailing Address - Country:US
Mailing Address - Phone:302-655-8717
Mailing Address - Fax:803-691-6825
Practice Address - Street 1:1304 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4266
Practice Address - Country:US
Practice Address - Phone:302-655-8717
Practice Address - Fax:803-691-6825
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery