Provider Demographics
NPI:1427195940
Name:KING, DENNISE (MBA)
Entity Type:Individual
Prefix:MS
First Name:DENNISE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 21ST CT SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-3368
Mailing Address - Country:US
Mailing Address - Phone:772-567-3568
Mailing Address - Fax:772-562-9720
Practice Address - Street 1:320 21ST CT SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-3368
Practice Address - Country:US
Practice Address - Phone:772-567-3568
Practice Address - Fax:772-562-9720
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator