Provider Demographics
NPI:1821433004
Name:ADEAN KINGSTON MD PLLC
Entity Type:Organization
Organization Name:ADEAN KINGSTON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEAN
Authorized Official - Middle Name:AUDACE
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-420-3376
Mailing Address - Street 1:4514 COLE AVE
Mailing Address - Street 2:SUITE 910
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5412
Mailing Address - Country:US
Mailing Address - Phone:214-420-3376
Mailing Address - Fax:214-420-3630
Practice Address - Street 1:4514 COLE AVE
Practice Address - Street 2:SUITE 910
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5412
Practice Address - Country:US
Practice Address - Phone:214-420-3376
Practice Address - Fax:214-420-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0170207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty