Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | P-153 | LA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | P-153 | LA |
NPI | 1669541231 |
---|---|
Provider Name | Dr. Brett King |
First Address | New Orleans, LA 70119 |
Second Address | New Orleans, LA 70118-5720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 25/11/2020 |