Provider Demographics
NPI:1669523627
Name:KING, MELINDA RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:RENEE
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:RENEE
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7402 HIGHWAY 69 S
Mailing Address - Street 2:SUITE H
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-1300
Mailing Address - Country:US
Mailing Address - Phone:205-344-9220
Mailing Address - Fax:205-344-9221
Practice Address - Street 1:7402 HIGHWAY 69 S
Practice Address - Street 2:SUITE H
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-1300
Practice Address - Country:US
Practice Address - Phone:205-344-9220
Practice Address - Fax:205-344-9221
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO55021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630500110Medicaid