Provider Demographics
NPI:1538267430
Name:KING, PATRICK DESMOND SR (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DESMOND
Last Name:KING
Suffix:SR
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:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:LOVINGSTON
Mailing Address - State:VA
Mailing Address - Zip Code:22949-0413
Mailing Address - Country:US
Mailing Address - Phone:434-263-5067
Mailing Address - Fax:434-263-5535
Practice Address - Street 1:400 COURT STREET
Practice Address - Street 2:
Practice Address - City:LOVINGSTON
Practice Address - State:VA
Practice Address - Zip Code:22949
Practice Address - Country:US
Practice Address - Phone:434-263-5067
Practice Address - Fax:434-263-5535
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA004442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist