Provider Demographics
NPI:1083717664
Name:KINGSLEY, SCOTT B (DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861
Mailing Address - Country:US
Mailing Address - Phone:207-354-6453
Mailing Address - Fax:207-354-8757
Practice Address - Street 1:4 CONGO AVE
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:ME
Practice Address - Zip Code:04861
Practice Address - Country:US
Practice Address - Phone:207-354-6453
Practice Address - Fax:207-354-8757
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME28781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice