Provider Demographics
NPI:1265554141
Name:HASKELL C. KINGSTON D.M.D.,P.A.
Entity type:Organization
Organization Name:HASKELL C. KINGSTON D.M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HASKELL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-439-0779
Mailing Address - Street 1:17 LEVESQUE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-2075
Mailing Address - Country:US
Mailing Address - Phone:207-439-0779
Mailing Address - Fax:207-439-0883
Practice Address - Street 1:17 LEVESQUE DR STE 3
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2075
Practice Address - Country:US
Practice Address - Phone:207-439-0779
Practice Address - Fax:207-439-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME29141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112670000Medicaid