Organization
KINGSTON DENTAL LLC
Active
Parent organization
KINGSTON DENTAL LLC
Other names
Mobile Unit 24
Organization subpart
Yes
Provider details
NPI number
Legal business name
KINGSTON DENTAL LLC
Authorized official
DR. EVON HULSE DDS (OWNER)
(865) 804-2531
Entity
Organization
Contact information
Practice address
820 N KENTUCKY ST, KINGSTON, TN 37763-2635
(865) 804-2531
(865) 966-1229
Mailing address
820 N KENTUCKY ST, KINGSTON, TN 37763-2635
(865) 804-2531
(865) 966-1229
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8110
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18362
DORAL DENTAL OF TN
TN
Enumeration date
06/05/2008
Last updated
05/10/2010
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