Provider Demographics
NPI:1538246657
Name:KINGSTON, HASKELL CHARLES (DMD)
Entity type:Individual
Prefix:
First Name:HASKELL
Middle Name:CHARLES
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME030541OtherBLUE CROSS ID NUMBER