Provider Demographics
NPI:1730351040
Name:KING FAMILY DENTAL CARE, PC
Entity type:Organization
Organization Name:KING FAMILY DENTAL CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-435-0677
Mailing Address - Street 1:915 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2735
Mailing Address - Country:US
Mailing Address - Phone:229-435-0677
Mailing Address - Fax:229-439-0533
Practice Address - Street 1:915 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2735
Practice Address - Country:US
Practice Address - Phone:229-435-0677
Practice Address - Fax:229-439-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9184393Medicaid