Individual
DR. SHAUNTA' SHAWAN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
8500 W 110TH ST STE 450, OVERLAND PARK, KS 66210-4029
(404) 919-5898
Mailing address
PO BOX 2604, RINCON, GA 31326-2604
(404) 919-5898
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN014131
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
877878469A
—
GA
05
—
877878469B
—
GA
01
—
DN014131
DMD LICENSE
GA
Enumeration date
07/22/2010
Last updated
05/07/2021
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