Provider Demographics
NPI:1154611176
Name:KING, DEREK TIMOTHY (DMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:TIMOTHY
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 1:3695 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4516
Mailing Address - Country:US
Mailing Address - Phone:561-364-1800
Mailing Address - Fax:
Practice Address - Street 1:3695 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4516
Practice Address - Country:US
Practice Address - Phone:561-364-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFK39078531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery