# KINGMAN FAMILY DENTAL GROUP LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1235955592
- **Authorized official:** MERCEDES FIGUEROA (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (623) 289-3392

## Contact information

- **Practice address:** 1751 N STOCKTON HILL RD STE A, KINGMAN, AZ 86401-6601
- **Practice address phone:** (928) 718-8668
- **Mailing address:** 19601 N BLACK CANYON HWY \# 201, PHOENIX, AZ 85027-4107
- **Mailing address phone:** (623) 289-3392
- **Mailing address fax:** (623) 289-2015

## Taxonomy

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

## Other

- **Enumeration date:** 12/02/2024
- **Last updated:** 12/02/2024