Provider Demographics
NPI:1881420768
Name:KING FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:KING FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-799-9234
Mailing Address - Street 1:1696 FAIRVIEW BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-5144
Mailing Address - Country:US
Mailing Address - Phone:615-799-9234
Mailing Address - Fax:
Practice Address - Street 1:1696 FAIRVIEW BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-5144
Practice Address - Country:US
Practice Address - Phone:615-799-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty