Provider Demographics
NPI:1497735146
Name:KING, DENNIS SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SAMUEL
Last Name:KING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 VILLAGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4735
Mailing Address - Country:US
Mailing Address - Phone:402-421-6611
Mailing Address - Fax:402-421-7067
Practice Address - Street 1:6100 VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4735
Practice Address - Country:US
Practice Address - Phone:402-421-6611
Practice Address - Fax:402-421-7067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice