Provider Demographics
NPI:1417524265
Name:KING, JOSHUA MARK (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
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 1:75 W 200 S
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-9707
Mailing Address - Country:US
Mailing Address - Phone:435-640-2340
Mailing Address - Fax:
Practice Address - Street 1:365 E LOMOND VIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-2769
Practice Address - Country:US
Practice Address - Phone:801-782-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12662883-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist