Provider Demographics
NPI:1265466163
Name:KING, WAYNE L (DMD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:L
Last Name:KING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4209
Mailing Address - Country:US
Mailing Address - Phone:843-797-5400
Mailing Address - Fax:843-797-5164
Practice Address - Street 1:7465 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4209
Practice Address - Country:US
Practice Address - Phone:843-797-5400
Practice Address - Fax:843-797-5164
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-16961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ16965Medicaid
SCZ16965Medicaid