Provider Demographics
NPI:1275734584
Name:KINGSLEY, MONTY CARL (DDS)
Entity Type:Individual
Prefix:MR
First Name:MONTY
Middle Name:CARL
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-1608
Mailing Address - Country:US
Mailing Address - Phone:970-842-2494
Mailing Address - Fax:970-842-5217
Practice Address - Street 1:242 CAMBRIDGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-1608
Practice Address - Country:US
Practice Address - Phone:970-842-2494
Practice Address - Fax:970-842-5217
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist