Provider Demographics
NPI:1316272198
Name:KING, MARK ALLEN (DMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:KING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:107 FRAZIER COURT
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8973
Mailing Address - Country:US
Mailing Address - Phone:502-570-5700
Mailing Address - Fax:502-570-5707
Practice Address - Street 1:107 FRAZIER COURT
Practice Address - Street 2:SUITE 1D
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8973
Practice Address - Country:US
Practice Address - Phone:502-570-5700
Practice Address - Fax:502-570-5707
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY87291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics