Provider Demographics
NPI:1578717039
Name:KING SMILES IV, PA
Entity Type:Organization
Organization Name:KING SMILES IV, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:FONCELL
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-832-6225
Mailing Address - Street 1:2407 S CONGRESS AVE
Mailing Address - Street 2:100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5505
Mailing Address - Country:US
Mailing Address - Phone:512-832-6225
Mailing Address - Fax:512-832-8448
Practice Address - Street 1:2407 S CONGRESS AVE
Practice Address - Street 2:100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5505
Practice Address - Country:US
Practice Address - Phone:512-832-6225
Practice Address - Fax:512-832-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty