Provider Demographics
NPI:1255426706
Name:KING, LINDA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JEAN
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3758 HIGHWAY 42
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248
Mailing Address - Country:US
Mailing Address - Phone:770-898-8872
Mailing Address - Fax:678-432-1209
Practice Address - Street 1:3758 HIGHWAY 42
Practice Address - Street 2:SUITE 303
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248
Practice Address - Country:US
Practice Address - Phone:770-898-8872
Practice Address - Fax:678-432-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice