# KINGSTON DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083860498
- **Authorized official:** DR. EVON ELIZABETH HULSE D.D.S. (BOARD MEMBER)
- **Authorized official phone:** (865) 640-5283

## Contact information

- **Practice address:** 1212 N KENTUCKY ST, KINGSTON, TN 37763-2328
- **Practice address phone:** (865) 717-3586
- **Practice address fax:** (865) 717-3581
- **Mailing address:** 1203 OLD N KENTUCKY ST, KINGSTON, TN 37763-2358
- **Mailing address phone:** (865) 717-3586
- **Mailing address fax:** (865) 717-3581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8110 | TN | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 10/02/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1515194 | — | TN |