Provider Demographics
NPI:1316505720
Name:KING ORAL SURGERY ASSOCIATES LLC
Entity type:Organization
Organization Name:KING ORAL SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-293-3744
Mailing Address - Street 1:4255 ALTAMONT PL STE 302
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3082
Mailing Address - Country:US
Mailing Address - Phone:301-645-4555
Mailing Address - Fax:
Practice Address - Street 1:4255 ALTAMONT PL STE 302
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3082
Practice Address - Country:US
Practice Address - Phone:301-645-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty