Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6647 | IA |
NPI | 1023060365 |
---|---|
Provider Name | Dr. Edwin D King |
First Address | Waterloo, IA 50702 |
Second Address | Waterloo, IA 50702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18360 | BLUE CROSS BLUE SHIELD (01) | IA |
183608 | DENTAL INSURANCES (01) | IA |
T01055 | (02) |