Ordie H. King Jr., D.D.S., PH.D.
Individual provider Active NPI Oral and Maxillofacial Pathology Dentistry · Godfrey, IL
NPI 1700920113 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1700920113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Pathology Dentistry 1223P0106X
- Practice address
- 6111 Vollmer LN
Godfrey, IL 62035-1062 - Phone
- (618) 466-3645
- Fax
- (618) 466-3410
- NPI assigned
- Feb 18, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.015454 | IL | MD | Oral and Maxillofacial Pathology Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Iilinois Pathology Laboratory LTD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | IL | Yes |
Addresses
Primary practice location
6111 Vollmer LN
Godfrey, IL 62035-1062
Mailing address
PO Box 1166
Alton, IL 62002-1166
Phone (618) 466-3645
Other providers in Godfrey, IL
- Illini Optometric PC
- Felecia Marie Ivanuck
- Lisa K James
- Jeanie M. Thompson, MD PC
- Judith Bohringer
- Julie Ann Kline
- Donna L Koenig
- Lynda Krueger
- Larry W. Crocker DMD, PC
- Amy Christine Laughlin
All providers in Godfrey, IL · Oral and Maxillofacial Pathology Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.