Basic Information
Provider Information
NPI: 1285971549
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KING
FirstName: JOSEPH
MiddleName: MAURICE
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 427 S GOLDEN GATE AVE
Address2:  
City: STOCKTON
State: CA
PostalCode: 952056646
CountryCode: US
TelephoneNumber: 4154246406
FaxNumber:  
Practice Location
Address1: 9130 ALCOSTA BLVD STE A
Address2:  
City: SAN RAMON
State: CA
PostalCode: 945833847
CountryCode: US
TelephoneNumber: 9258039700
FaxNumber: 9258032568
Other Information
ProviderEnumerationDate: 01/07/2013
LastUpdateDate: 01/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X62119CAY Dental ProvidersDentist 

No ID Information.


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