Provider Demographics
NPI:1295803088
Name:KING DENTAL LLC
Entity type:Organization
Organization Name:KING DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:KING
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-562-0811
Mailing Address - Street 1:1400 SPRING ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2735
Mailing Address - Country:US
Mailing Address - Phone:301-562-0811
Mailing Address - Fax:301-562-1308
Practice Address - Street 1:1400 SPRING ST
Practice Address - Street 2:SUITE 420
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2735
Practice Address - Country:US
Practice Address - Phone:301-562-0811
Practice Address - Fax:301-562-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty