Organization
GASTONIA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE CARSON KINGSBURY DMD (OWNER)
(904) 710-8011
Entity
Organization
Contact information
Practice address
2557 PEMBROKE RD, GASTONIA, NC 28054-4712
(704) 854-8887
Mailing address
2557 PEMBROKE RD, GASTONIA, NC 28054-4712
(704) 854-8887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8726
NC
122300000X
Dentist
9309
NC
122300000X
Dentist
Primary
9534
NC
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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