Active NPI
Charles Clinton King Sr., DMD
- General Practice Dentistry
- Albany, GA
National Provider Identifier
1295804037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN009643
- Practice address
- 915 W Highland Ave
Albany, GA 31701-2735 - Phone
- (229) 435-0677
- Fax
- (229) 439-0533
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN009643 | GA | Primary |
Addresses
Primary practice location
915 W Highland Ave
Albany, GA 31701-2735
Mailing address
605 Honeysuckle Dr
Albany, GA 31705-9177
Phone (229) 435-7732
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000247288-A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN009643 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| King Family Dental Care, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Albany, GA
- NPI 1730351040
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295804037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 HONEYSUCKLE DR",
"city": "ALBANY",
"state": "GA",
"postal_code": "317059177",
"telephone_number": "229-435-7732",
"fax_number": "229-439-0533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 W HIGHLAND AVE",
"city": "ALBANY",
"state": "GA",
"postal_code": "317012735",
"telephone_number": "229-435-0677",
"fax_number": "229-439-0533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "CHARLES",
"middle_name": "CLINTON",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN009643",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000247288-A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.