Healthcare Provider Details

I. General information

NPI: 1265836274
Provider Name (Legal Business Name): STEPHEN KINGSTON D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 2ND ST STE 220
SANTA MONICA CA
90403-5013
US

IV. Provider business mailing address

1137 2ND ST STE 220
SANTA MONICA CA
90403-5013
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-8103
  • Fax:
Mailing address:
  • Phone: 310-451-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: