NPIMap

Organization Active NPI

Kingston Dental LLC

  • General Practice Dentistry
  • Kingston, TN
National Provider Identifier
1083860498
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8110 Issued in TN
Legal business name
KINGSTON DENTAL LLC
Practice address
1212 N Kentucky St
Kingston, TN 37763-2328
Phone
(865) 717-3586
Fax
(865) 717-3581
NPI assigned
Aug 18, 2008
Last updated
Oct 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Evon Elizabeth Hulse, D.D.S.NPI 1356330229
Title
Board Member
Phone
(865) 640-5283

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8110 TN Primary

Addresses

Primary practice location

1212 N Kentucky St
Kingston, TN 37763-2328

Mailing address

1203 Old N Kentucky St
Kingston, TN 37763-2358
Phone (865) 717-3586

Other identifiers 1

IdentifierTypeStateIssuer
1515194MedicaidTN

National Provider Directory

National Provider Directory
Tax ID family
Kingston Dental LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 8

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1083860498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 OLD N KENTUCKY ST",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377632358",
            "telephone_number": "865-717-3586",
            "fax_number": "865-717-3581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 N KENTUCKY ST",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377632328",
            "telephone_number": "865-717-3586",
            "fax_number": "865-717-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-18",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "HULSE",
        "authorized_official_first_name": "EVON",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "865-640-5283",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1515194",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.