Provider Demographics
NPI:1710856455
Name:PD - KINGSTON LLC
Entity type:Organization
Organization Name:PD - KINGSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER STRATEGY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-355-2965
Mailing Address - Street 1:280 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5136
Mailing Address - Country:US
Mailing Address - Phone:570-287-3009
Mailing Address - Fax:570-287-8698
Practice Address - Street 1:280 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5136
Practice Address - Country:US
Practice Address - Phone:570-287-3009
Practice Address - Fax:570-287-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty