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General NPI Number Information
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NPI Number | 1013710565
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Entity Type | Organization
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Legal Business Name | KINGSTONDEV LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 7800 US HIGHWAY 98 W
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-7228
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Country | US
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Telephone | 504-249-3805
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Fax |
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Provider Business Mailing Address
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Address Line | 508 MILLAUDON ST
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City | NEW ORLEANS
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State | LA
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Zip | 70118-3805
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Country | US
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Telephone | 504-881-3652
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Fax |
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Authorized Official
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Title or Position | SURGEON
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Name | DR. SUMA MADDOX
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Credential | MD
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Telephone | 504-249-3805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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