Provider Demographics
NPI:1134275878
Name:KING, SILVIA REGINA (DDS)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:REGINA
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 GASTON AVE
Mailing Address - Street 2:ROOM 203A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2013
Mailing Address - Country:US
Mailing Address - Phone:214-828-8133
Mailing Address - Fax:214-874-4508
Practice Address - Street 1:3302 GASTON AVE
Practice Address - Street 2:ROOM 203A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2013
Practice Address - Country:US
Practice Address - Phone:214-828-8133
Practice Address - Fax:214-874-4508
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295777324Medicaid
TX1134162746Medicaid
TX19321OtherCDC CHIP
TX111206204Medicaid
TX111206202Medicaid