Provider Demographics
NPI:1760257844
Name:DR MATTHEW KING DDS INC
Entity Type:Organization
Organization Name:DR MATTHEW KING DDS INC
Other - Org Name:WINCHESTER DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-567-5978
Mailing Address - Street 1:29432 WYATT EARP WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-7608
Mailing Address - Country:US
Mailing Address - Phone:360-567-5978
Mailing Address - Fax:
Practice Address - Street 1:27521 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2600
Practice Address - Country:US
Practice Address - Phone:951-676-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental