Provider Demographics
NPI:1992958995
Name:KING, SUE ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 N 4TH ST
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:FLAFSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004
Mailing Address - Country:US
Mailing Address - Phone:928-526-4610
Mailing Address - Fax:928-526-2330
Practice Address - Street 1:2708 N 4TH ST
Practice Address - Street 2:SUITE A-4
Practice Address - City:FLAFSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-526-4610
Practice Address - Fax:928-526-2330
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist