Provider Demographics
NPI:1316163074
Name:KING, CHARLES J (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 WILLOW STREET PIKE N
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9585
Mailing Address - Country:US
Mailing Address - Phone:717-464-5534
Mailing Address - Fax:
Practice Address - Street 1:2534 WILLOW STREET PIKE N
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9585
Practice Address - Country:US
Practice Address - Phone:717-464-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022138-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice