Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4120 | OK |
NPI | 1043202278 |
---|---|
Provider Name | Dr. Philip Joseph King |
First Address | Fpo, AP 96350 1821 |
Second Address | Fpo, AP 96350 1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 20/04/2008 |