Provider Demographics
NPI:1790925881
Name:KING, DONALD DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DEAN
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 1:3004 JAVA RD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3506
Mailing Address - Country:US
Mailing Address - Phone:714-540-0854
Mailing Address - Fax:
Practice Address - Street 1:3004 JAVA RD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3506
Practice Address - Country:US
Practice Address - Phone:714-540-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist