Provider Demographics
NPI:1164711925
Name:KINGSTON FAMILY DENTAL
Entity Type:Organization
Organization Name:KINGSTON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSHKALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-580-5925
Mailing Address - Street 1:53 CHURCH ST
Mailing Address - Street 2:P.O. BOX 39
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-9997
Mailing Address - Country:US
Mailing Address - Phone:603-347-1327
Mailing Address - Fax:603-952-3440
Practice Address - Street 1:53 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-9997
Practice Address - Country:US
Practice Address - Phone:603-347-1327
Practice Address - Fax:603-952-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH038201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty