Provider Demographics
NPI:1063690378
Name:KING SMILES II, P.A.
Entity type:Organization
Organization Name:KING SMILES II, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORD.
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:FONCELL
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-832-8448
Mailing Address - Street 1:208 SENDERA BONITA
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3951
Mailing Address - Country:US
Mailing Address - Phone:512-507-8468
Mailing Address - Fax:512-832-8454
Practice Address - Street 1:208 SENDERA BONITA
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-3951
Practice Address - Country:US
Practice Address - Phone:512-507-8468
Practice Address - Fax:512-832-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty