Provider Demographics
NPI:1437518826
Name:KING DENTAL CENTER
Entity Type:Organization
Organization Name:KING DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KING
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-881-6980
Mailing Address - Street 1:15725 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-3216
Mailing Address - Country:US
Mailing Address - Phone:313-881-6980
Mailing Address - Fax:313-881-0090
Practice Address - Street 1:15725 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3216
Practice Address - Country:US
Practice Address - Phone:313-881-6980
Practice Address - Fax:313-881-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty