Thomas J King III, DDS MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

08393 Issued in IA

Practice address

100 Bryant St
Dubuque, IA 52003

Phone

(563) 557-1440

Fax

(563) 557-7001

NPI assigned

Dec 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2016 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tking3933873@direct.trinity-health.org

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.

• Great River Oral and Maxillofacial Surgery PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Dubuque, IA
  • NPI 1992799811
  NPD (past)

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297296000000",
    "number": "1942287875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BRYANT ST",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "52003",
            "telephone_number": "563-557-1440",
            "fax_number": "563-557-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BRYANT ST",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "52003",
            "telephone_number": "563-557-1440",
            "fax_number": "563-557-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_suffix": "III",
        "credential": "DDS MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2011-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "47958",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "08393",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "5844015",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11448",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019026707",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IA",
            "license": "36804",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WI",
            "license": "49434020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33799700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "190009751",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0493957",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170198300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "14582",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camry Kieler, PT
• Miranda Ashley Kieler, LMSW
• Brett N Kilburg, DDS
• Jodi Nicole Kilburg, ARNP
• Kristin Kilburg, OT
• Tyler King
• Katrina Lynn Kinowski, DC
• Annemarie Kircher, PT
• Matthew J. Kirkendall, M.D.
• Kathleen Ann Klapatauskas, PT

• Oral and Maxillofacial Surgery (Dentist) in Dubuque, IA
• Providers in Dubuque, IA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.