Provider Demographics
NPI:1487826665
Name:KINGSTON DENTAL PC
Entity Type:Organization
Organization Name:KINGSTON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-676-7778
Mailing Address - Street 1:8618 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4434
Mailing Address - Country:US
Mailing Address - Phone:718-676-7778
Mailing Address - Fax:718-676-7686
Practice Address - Street 1:8618 25TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4434
Practice Address - Country:US
Practice Address - Phone:718-676-7778
Practice Address - Fax:718-676-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02320661Medicaid