Provider Demographics
NPI:1558420521
Name:KING, JASMINE COLEMAN
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:COLEMAN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 SUMMER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2094
Mailing Address - Country:US
Mailing Address - Phone:817-292-7488
Mailing Address - Fax:
Practice Address - Street 1:7841 SUMMER CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2094
Practice Address - Country:US
Practice Address - Phone:817-292-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice