Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5515 | ME |
NPI | 1700015526 |
---|---|
Provider Name | Dr. Joseph S Kingston |
First Address | Bangor, ME 04401-4443 |
Second Address | Bangor, ME 04401-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 16/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1700015526 | (05) | ME |