Provider Demographics
NPI:1710924576
Name:KING, DENNIS E (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:E
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 FORAND CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-2611
Mailing Address - Country:US
Mailing Address - Phone:941-815-1411
Mailing Address - Fax:
Practice Address - Street 1:3100 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6914
Practice Address - Country:US
Practice Address - Phone:305-441-6810
Practice Address - Fax:305-529-6797
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS85262085R0202X
IN02000656SA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263036200Medicaid
OH3159657Medicaid
IN100327320Medicaid
FLE6428TMedicare PIN
INM400047755Medicare PIN
INP00950294Medicare PIN
D94827Medicare UPIN
OH3159657Medicaid