Organization
BLAKE KINGSBURY DMD PLLC
Active
Other names
Godel Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE CARSON KINGSBURY D.M.D (DENTIST)
(704) 854-8887
Entity
Organization
Contact information
Practice address
2557 PEMBROKE RD, 2557 PEMBROKE RD, GASTONIA, NC 28054-4712
(704) 854-8887
(704) 854-8893
Mailing address
2557 PEMBROKE RD, GASTONIA, NC 28054-4712
(704) 854-8887
(704) 854-8893
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831338276
DENTAL
NC
Enumeration date
03/21/2013
Last updated
03/21/2013
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