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Individual

THOMAS J KING III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS MD

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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