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NPI Code Detail

MEDICARE: KINGSTON DENTAL LLC

MEDICARE: KINGSTON DENTAL LLC
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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118362OTHERTNDORAL DENTAL OF TN

General Provider Information

NPI Number : 1558524173
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGSTON DENTAL LLC
Provider Business Mailing Address
First Line : 820 N KENTUCKY ST
Second Line :
City : KINGSTON
State : TN
Zip : 37763-2635
Country : US
Telephone Number : 865-804-2531
Fax Number : 865-966-1229
Provider Business Practice Location Address
First Line : 820 N KENTUCKY ST
Second Line :
City : KINGSTON
State : TN
Zip : 37763-2635
Country : US
Telephone Number : 865-804-2531
Fax Number : 865-966-1229
Authorized Official
Title or Position : CO-OWNER
Name : DR. EVON HULSE
Credential : DDS
Telephone Number : 865-804-2531
Provider Enumeration Date : 07/03/2008
Last Update Date : 05/14/2010

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Directions to “KINGSTON DENTAL LLC ” Practice Location

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