Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 23939 | TX |
NPI | 1033131362 |
---|---|
Provider Name | Dr. Timothy Mark King |
First Address | San Antonio, TX 78232-1404 |
Second Address | San Antonio, TX 78232-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 22/12/2011 |