Provider Demographics
NPI:1962519017
Name:KING, E SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:SCOTT
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 1:1215 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 1 AND 1
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6374
Mailing Address - Country:US
Mailing Address - Phone:626-796-5593
Mailing Address - Fax:626-796-3483
Practice Address - Street 1:1215 W HUNTINGTON DR
Practice Address - Street 2:SUITE 1 AND 1
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6374
Practice Address - Country:US
Practice Address - Phone:626-796-5593
Practice Address - Fax:626-796-3483
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4923OtherPACIFIC UNION
CAP6870OtherPACIFIC CARE