# KINGMAN DENTAL PROFESSIONALS, LLC

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

## Provider details

- **NPI number:** 1144832940
- **Authorized official:** JOHN LUNDGREEN (MEMBER/CEO)
- **Authorized official phone:** (480) 295-9234

## Contact information

- **Practice address:** 3775 N STOCKTON HILL RD, KINGMAN, AZ 86409-3219
- **Practice address phone:** (480) 295-9234
- **Mailing address:** 7205 E SOUTHERN AVE STE A-122, MESA, AZ 85209-2790
- **Mailing address phone:** (480) 295-9234

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/21/2020
- **Last updated:** 08/21/2020