Provider Demographics
NPI:1376719203
Name:KINGSTON, ALAN BRUCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BRUCE
Last Name:KINGSTON
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 1:101 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2104
Mailing Address - Country:US
Mailing Address - Phone:407-862-1211
Mailing Address - Fax:407-862-5359
Practice Address - Street 1:101 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2104
Practice Address - Country:US
Practice Address - Phone:407-862-1211
Practice Address - Fax:407-862-5359
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist