Organization
KINGSTON DENTAL LLC
Active
Parent organization
KINGSTON DENTAL LLC
Other names
Mobile 4
Organization subpart
Yes
Provider details
NPI number
Legal business name
KINGSTON DENTAL LLC
Authorized official
DR. EVON HULSE DDS (CO-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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18362
DORAL DENTAL OF TN
TN
Enumeration date
07/03/2008
Last updated
05/14/2010
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