Provider Demographics
NPI:1639683634
Name:BC KING DDS PC
Entity Type:Organization
Organization Name:BC KING DDS PC
Other - Org Name:KING DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER/PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-392-3886
Mailing Address - Street 1:102 E 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026
Mailing Address - Country:US
Mailing Address - Phone:573-392-3886
Mailing Address - Fax:573-392-5867
Practice Address - Street 1:102 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1605
Practice Address - Country:US
Practice Address - Phone:573-392-3886
Practice Address - Fax:573-392-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty