Mundo Management Group, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

8552 Issued in SC

Legal business name

MUNDO MANAGEMENT GROUP, LLC

Practice address

3463 Highway 21 Byp Ste 1
Fort Mill, SC 29715-7245

Phone

(704) 825-2081

Fax

(803) 335-5189

NPI assigned

Jun 25, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Blake Carson Kingsbury, DMD

Title

Dr. Blake Kingsbury, D.M.D

Phone

(704) 825-2081

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mundo Management Other name

Locations

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1922480060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3463 HIGHWAY 21 BYP STE 1",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157245",
            "telephone_number": "704-825-2081",
            "fax_number": "803-335-5189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3463 HIGHWAY 21 BYP STE 1",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157245",
            "telephone_number": "704-825-2081",
            "fax_number": "803-335-5189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNDO MANAGEMENT GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "KINGSBURY",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "CARSON",
        "authorized_official_title_or_position": "DR. BLAKE KINGSBURY, D.M.D",
        "authorized_official_telephone_number": "704-825-2081",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SC",
            "license": "8552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831338276",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mundo Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Imani Nechele Moye
• Amelia Mudd
• Linda Joann Mullinix, LMFT
• Multifaceted Mindset
• Mundo Dental Group, PA
• Charlotte Heaver Myers, NP
• Sarah Darsey Myers, LISW-CP
• Myeyedr Optometry of South Carolina, LLC
• Myhja LLC
• Alissa Mynhier, LPC

• Dentist in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.