King George Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

0401413422 Issued in VA

Legal business name

KING GEORGE DENTAL LLC

Practice address

15521 Real Estate Ave
Ste 200
King George, VA 22485-5327

Phone

(540) 663-3139

NPI assigned

Oct 17, 2012

Last updated

Dec 6, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Philip James Spory, DDSNPI 1740437672

Title

President

Phone

(540) 663-3139

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Philip James Spory, DDS

  • Dentist
  • King George, VA
  • NPI 1740437672
  Authorized official Same address or phone

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1538412424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15521 REAL ESTATE AVE",
            "address_2": "STE 200",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224855327",
            "telephone_number": "540-663-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15521 REAL ESTATE AVE",
            "address_2": "STE 200",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224855327",
            "telephone_number": "540-663-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING GEORGE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "SPORY",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-663-3139",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401413422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5057872",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edwin Charles Khonyongwa, LALFA, LPN
• Bawul Kim
• Min Seong Kim, DMD
• King George County (King George County Department of Fire, Rescue, & Emergency Services)
• King George County Schools
• King George Family Doctors, LLC
• King George Life Care, LLC (Heritage Hall - King George)
• King George Life Care, LLC (Heritage Hall - King George)
• King George Medical Center LTD
• King George Pharmacy, Inc.

• Dentist in King George, VA
• Providers in King George, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.