# KINGSTON DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KINGSTON DENTAL LLC
- **Other names:** Mobile 33
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548423163
- **Legal business name:** KINGSTON DENTAL LLC
- **Authorized official:** DR. EVON HULSE DDS (CO-OWNER)
- **Authorized official phone:** (865) 804-2465

## Contact information

- **Practice address:** 820 N KENTUCKY ST, KINGSTON, TN 37763-2635
- **Practice address phone:** (865) 804-2465
- **Practice address fax:** (865) 966-1229
- **Mailing address:** 820 N KENTUCKY ST, KINGSTON, TN 37763-2635
- **Mailing address phone:** (865) 804-2465
- **Mailing address fax:** (865) 966-1229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/03/2008
- **Last updated:** 05/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 18362 | DORAL DENTAL OF TN | TN |