Basic Information
| Provider Information | |||||||||
| NPI: | 1922160209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | NEILSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 MULE CREEK DR | ||||||||
| Address2: | |||||||||
| City: | WENTZVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633857410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162869026 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 950 UNSER BLVD SE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RIO RANCHO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058922900 | ||||||||
| FaxNumber: | 5058922913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DD4065 | NM | N | Dental Providers | Dentist | General Practice | 1223G0001X | 2006014152 | MO | Y | Dental Providers | Dentist | General Practice |
No ID Information.