Provider Demographics
NPI:1821126483
Name:KING, ANTHONY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
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 1:1007 W FULTON MARKET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1222
Mailing Address - Country:US
Mailing Address - Phone:312-733-1020
Mailing Address - Fax:312-733-1011
Practice Address - Street 1:1007 W FULTON MARKET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1222
Practice Address - Country:US
Practice Address - Phone:312-733-1020
Practice Address - Fax:312-733-1011
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190243361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice