Provider Demographics
NPI:1053518449
Name:KINGSTON, PETER JON (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JON
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 N WASHINGTON ST
Mailing Address - Street 2:SUITE #8
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2662
Mailing Address - Country:US
Mailing Address - Phone:734-482-5350
Mailing Address - Fax:
Practice Address - Street 1:32 N WASHINGTON ST
Practice Address - Street 2:SUITE #8
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2662
Practice Address - Country:US
Practice Address - Phone:734-482-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010115821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice