Provider Demographics
NPI:1720186810
Name:KING, GEORGE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:KING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5084 N FRUIT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3000
Mailing Address - Country:US
Mailing Address - Phone:559-226-3686
Mailing Address - Fax:559-226-0947
Practice Address - Street 1:5084 N FRUIT AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3000
Practice Address - Country:US
Practice Address - Phone:559-226-3686
Practice Address - Fax:559-226-3686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720186810OtherNPI