Provider Demographics
NPI:1306908991
Name:KING, DANIEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DANNY
Other - Middle Name:ARIC
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3719 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:770-777-1222
Mailing Address - Fax:678-336-1597
Practice Address - Street 1:3719 OLD ALABAMA RD
Practice Address - Street 2:SUITE 400B
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-777-1222
Practice Address - Fax:678-336-1597
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADPCS000050122300000X
GADN0129191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA292282708EMedicaid