Basic Information
| Provider Information | |||||||||
| NPI: | 1063690378 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KING SMILES II, P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 208 SENDERA BONITA | ||||||||
| Address2: | |||||||||
| City: | LAKEWAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787343951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125078468 | ||||||||
| FaxNumber: | 5128328454 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 SENDERA BONITA | ||||||||
| Address2: | |||||||||
| City: | LAKEWAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787343951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125078468 | ||||||||
| FaxNumber: | 5128328454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 02/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | POWERS | ||||||||
| AuthorizedOfficialFirstName: | JULIAN | ||||||||
| AuthorizedOfficialMiddleName: | FONCELL | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE COORD. | ||||||||
| AuthorizedOfficialTelephone: | 5128328448 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.