Provider Demographics
NPI:1487153680
Name:KING, KAITLIN ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ANNE
Last Name:KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RED HILL CIR APT G
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1722
Mailing Address - Country:US
Mailing Address - Phone:408-891-7251
Mailing Address - Fax:
Practice Address - Street 1:25 RED HILL CIR APT G
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1722
Practice Address - Country:US
Practice Address - Phone:408-891-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist