MEDICARE: BLAKE C KINGSBURY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8726	NC

General Provider Information

NPI Number	:	1831338276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE C KINGSBURY DMD

Provider Business Mailing Address
First Line	:	3 DOCTORS PARK STE C
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4521
Country	:	US
Telephone Number	:	828-617-0380
Fax Number	:	828-617-0381

Provider Business Practice Location Address
First Line	:	3 DOCTORS PARK STE C
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-4521
Country	:	US
Telephone Number	:	828-617-0380
Fax Number	:	828-617-0381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	01/12/2026

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