Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 06679 | IA |
NPI | 1477513356 |
---|---|
Provider Name | Dr. Thomas Arthur King |
First Address | Glenwood, IA 51534-1927 |
Second Address | Glenwood, IA 51534-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1059808 | (05) | IA |
U60759 | (02) |