Provider Demographics
NPI:1891360582
Name:KING, KIANA BANON (DMD)
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:BANON
Last Name:KING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KIANA
Other - Middle Name:
Other - Last Name:BANON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1206 JACKSON BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1274
Mailing Address - Country:US
Mailing Address - Phone:281-660-6399
Mailing Address - Fax:
Practice Address - Street 1:1850 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3004
Practice Address - Country:US
Practice Address - Phone:713-783-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1226705899231223G0001X
TX38638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice