NPIMap

Organization Active NPI

Gastonia Family Dentistry

  • Dentist
  • Gastonia, NC
National Provider Identifier
1558733410
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9534 Issued in NC
Legal business name
GASTONIA FAMILY DENTISTRY
Practice address
2557 Pembroke Rd
Gastonia, NC 28054-4712
Phone
(704) 854-8887
NPI assigned
Oct 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

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

Authorized official

Name
Dr. Blake Carson Kingsbury, DMDNPI 1831338276
Title
Owner
Phone
(904) 710-8011

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8726 NC
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 9309 NC
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 9534 NC Primary

Addresses

Primary practice location

2557 Pembroke Rd
Gastonia, NC 28054-4712

Mailing address

2557 Pembroke Rd
Gastonia, NC 28054-4712
Phone (704) 854-8887

National Provider Directory

National Provider Directory
Tax ID family
Blake Kingsbury DMD PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2557 Pembroke Rd
Gastonia, NC 28054
Phone (704) 854-8887

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446163200000",
    "number": "1558733410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2557 PEMBROKE RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544712",
            "telephone_number": "704-854-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2557 PEMBROKE RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280544712",
            "telephone_number": "704-854-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTONIA FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-30",
        "last_updated": "2015-10-30",
        "status": "A",
        "authorized_official_last_name": "KINGSBURY",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "CARSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-710-8011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "8726",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "9309",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "9534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; 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.