Kingston Dental LLC
Dentist, General Practice in Kingston, TN. Organization (NPI-2).
NPI number1174782007
StatusActive
Last updated in NPPESMay 10, 2010
Details
- NPI
- 1174782007
- Entity type
- Organization (NPI-2)
- Legal business name
- Kingston Dental LLC
- Organization subpart
- Yes
- Enumeration date
- Jun 5, 2008
- Last updated
- May 10, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 8110 | TN | Yes |
Other names
- Mobile Unit 24 (Other Name)
Practice location
820 N Kentucky StKingston, TN 37763-2635
Phone 865-804-2531 · Fax 865-966-1229
Mailing address
820 N Kentucky StKingston, TN 37763-2635
Phone 865-804-2531 · Fax 865-966-1229
Authorized official
Evon Hulse
Owner
8658042531
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