Basic Information
| Provider Information | |||||||||
| NPI: | 1710924576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1558 FORAND CIR | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339522611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418151411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3100 S DOUGLAS RD | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331346914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054416810 | ||||||||
| FaxNumber: | 3055296797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 01/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | OS8526 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 02000656SA | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 263036200 | 05 | FL | MEDICAID | 3159657 | 05 | OH | MEDICAID | 100327320 | 05 | IN | MEDICAID |