Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS4208 | TN |
NPI | 1043334824 |
---|---|
Provider Name | Thomas P King |
First Address | Kingsport, TN 37660 |
Second Address | Kingsport, TN 37660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |