NPIMap

Organization Active NPI

Kingston Dental LLC

  • General Practice Dentistry
  • Kingston, TN
National Provider Identifier
1174782007
Registry record updated May 10, 2010
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
820 N Kentucky St
Kingston, TN 37763-2635
Phone
(865) 804-2531
Fax
(865) 966-1229
NPI assigned
Jun 5, 2008
Organization subpart
Yes
Parent organization
KINGSTON DENTAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2010

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

Authorized official

Name
Dr. Evon Hulse, DDS
Title
Owner
Phone
(865) 804-2531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 8110 TN Primary

Addresses

Primary practice location

820 N Kentucky St
Kingston, TN 37763-2635

Mailing address

820 N Kentucky St
Kingston, TN 37763-2635
Phone (865) 804-2531

Other identifiers 1

IdentifierTypeStateIssuer
18362OtherTNDORAL DENTAL OF TN

Other names 1

  • Mobile Unit 24 Other name

National Provider Directory

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

Other organizations with this tax ID 8

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273449600000",
    "number": "1174782007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N KENTUCKY ST",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377632635",
            "telephone_number": "865-804-2531",
            "fax_number": "865-966-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 N KENTUCKY ST",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377632635",
            "telephone_number": "865-804-2531",
            "fax_number": "865-966-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KINGSTON DENTAL LLC",
        "enumeration_date": "2008-06-05",
        "last_updated": "2010-05-10",
        "status": "A",
        "authorized_official_last_name": "HULSE",
        "authorized_official_first_name": "EVON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-804-2531",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL OF TN",
            "identifier": "18362",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Unit 24",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 10, 2010; 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.