Individual
THOMAS J KING III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
100 BRYANT ST, DUBUQUE, IA 52003
(563) 557-1440
(563) 557-7001
Mailing address
100 BRYANT ST, DUBUQUE, IA 52003
(563) 557-1440
(563) 557-7001
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019026707
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
08393
IA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
5844015
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D11448
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
36804
IA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
47958
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
49434020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0493957
—
IA
01
—
14582
BLUE CROSS BLUE SHIELD
—
05
—
170198300
—
MN
01
—
190009751
RAILROAD MEDICARE
MN
05
—
33799700
—
WI
Enumeration date
12/30/2005
Last updated
02/10/2011
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