Jack E. King DDS Inc

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

30013512 Issued in OH

Legal business name

JACK E. KING DDS INC

Doing business as

King and Mayerson Orthodontics

Practice address

6460 Far Hills Avenue
Centerville, OH 45459

Phone

(937) 433-0830

Fax

(937) 433-9530

NPI assigned

Feb 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack E. King, DDS

Title

President

Phone

(937) 433-0830

Specialties & licenses 1

Addresses

Other names 1

• King and Mayerson Orthodontics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel B. King, DDS, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Centerville, OH
  • NPI 1346461969
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013051150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6460 FAR HILLS AVENUE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45459",
            "telephone_number": "937-433-0830",
            "fax_number": "937-433-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6460 FAR HILLS AVENUE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45459",
            "telephone_number": "937-433-0830",
            "fax_number": "937-433-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK E. KING DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-433-0830",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OH",
            "license": "30013512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King and Mayerson Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Debra A Jacobs, CPNP-PC

• Orthodontics and Dentofacial Orthopedics Dentistry in Centerville, OH
• Providers in Centerville, OH by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.