Provider Demographics
NPI:1871867895
Name:MICHAEL W KING, DDS, PLC
Entity Type:Organization
Organization Name:MICHAEL W KING, DDS, PLC
Other - Org Name:MICHAEL W KING, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-668-2354
Mailing Address - Street 1:2000 GREYSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3575
Mailing Address - Country:US
Mailing Address - Phone:731-668-2354
Mailing Address - Fax:731-668-2243
Practice Address - Street 1:2000 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3575
Practice Address - Country:US
Practice Address - Phone:731-668-2354
Practice Address - Fax:731-668-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty