Shellese A King, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6296 Issued in AZ

Practice address

907 E Cottonwood LN Ste 1
Casa Grande, AZ 85122-2226

Phone

(520) 876-5431

Fax

(520) 876-4875

NPI assigned

Apr 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Malingkas DMD PLLC

  • Pediatric Dentistry
  • Casa Grande, AZ
  • NPI 1265266175
  NPD
• Care for Kids of Arizona

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Mesa, AZ
  • NPI 1689715799

  General Practice

  NPD (past)
• Kid-1 Pediatric Dentistry

  • Pediatric Dentistry
  • Casa Grande, AZ
  • NPI 1568689776
  NPD (past)
• Squaw Peak Anesthesia Inc

  • Registered Nurse
  • Tempe, AZ
  • NPI 1134352925
  NPD (past)

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1790740512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E COTTONWOOD LN STE 1",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851222226",
            "telephone_number": "520-876-5431",
            "fax_number": "520-876-4875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E COTTONWOOD LN STE 1",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851222226",
            "telephone_number": "520-876-5431",
            "fax_number": "520-876-4875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SHELLESE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "919871",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalia Khudokonenko, LAC
• Kid-1 Pediatric Dentistry
• Megan Jo Kilgore, PHARMD
• Thomas Kim, PHARMD
• Laurie King, LCSW
• Kings Passion Home Care LLC
• Marissa Kirkendoll, PT, DPT
• Romas Joseph Kirvaitis, M.D.
• Jefre N Kleinhanzl
• Maria Kojs

• General Practice Dentistry in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.