Provider Demographics
NPI:1689809766
Name:KING, RACHEL L (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 SAYRE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5848
Mailing Address - Country:US
Mailing Address - Phone:413-695-2130
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN STREET, UMDNJ
Practice Address - Street 2:PEDIATRIC DENTISTRY DEPARTMENT, RM C-722
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02426400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist