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Organization

KINGSTON DENTAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EVON ELIZABETH HULSE D.D.S. (BOARD MEMBER)
(865) 640-5283
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8110
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1515194
TN
Enumeration date
08/18/2008
Last updated
10/02/2012
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