Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 045212 | NY |
NPI | 1083040471 |
---|---|
Provider Name | Marla C. King |
First Address | New York, NY 10022 |
Second Address | New York, NY 10022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 18/09/2013 |