Provider Demographics
NPI:1629207469
Name:KING, EARLE A (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-0667
Mailing Address - Country:US
Mailing Address - Phone:724-935-5323
Mailing Address - Fax:724-935-0717
Practice Address - Street 1:11200 PERRY HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-0717
Practice Address - Country:US
Practice Address - Phone:724-935-5323
Practice Address - Fax:724-935-0717
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018145L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics