Active NPI
Samuel L. King II, D.D.S.
- General Practice Dentistry
- Charleston, WV
National Provider Identifier
1578637781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2525
- Practice address
- 4844 Maccorkle Ave SW
Charleston, WV 25309-1340 - Phone
- (304) 768-6931
- Fax
- (304) 768-7881
- NPI assigned
- Nov 20, 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 | 2525 | WV | Primary |
Addresses
Primary practice location
4844 Maccorkle Ave SW
Charleston, WV 25309-1340
Mailing address
4844 Maccorkle Ave SW
Charleston, WV 25309-1340
Phone (304) 768-6931
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0133562000 | Medicaid | WV |
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 |
|---|---|---|---|
| 2525 | WV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578637781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4844 MACCORKLE AVE SW",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253091340",
"telephone_number": "304-768-6931",
"fax_number": "304-768-7881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4844 MACCORKLE AVE SW",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253091340",
"telephone_number": "304-768-6931",
"fax_number": "304-768-7881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "SAMUEL",
"middle_name": "L.",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "2525",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0133562000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.