Organization
MUNDO MANAGEMENT GROUP, LLC
Active
Other names
Mundo Management
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE CARSON KINGSBURY DMD (DR. BLAKE KINGSBURY, D.M.D)
(704) 825-2081
Entity
Organization
Contact information
Practice address
3463 HIGHWAY 21 BYP STE 1, FORT MILL, SC 29715-7245
(704) 825-2081
(803) 335-5189
Mailing address
3463 HIGHWAY 21 BYP STE 1, FORT MILL, SC 29715-7245
(704) 825-2081
(803) 335-5189
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8552
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831338276
—
NC
Enumeration date
06/25/2015
Last updated
06/25/2015
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