Provider Demographics
NPI:1447272893
Name:KINGSLEY, GEORGE JEROME (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JEROME
Last Name:KINGSLEY
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 1:3301 ALTA ARDEN EXPY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2121
Mailing Address - Country:US
Mailing Address - Phone:916-972-0788
Mailing Address - Fax:916-972-1305
Practice Address - Street 1:3301 ALTA ARDEN EXPY
Practice Address - Street 2:SUITE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2121
Practice Address - Country:US
Practice Address - Phone:916-972-0788
Practice Address - Fax:916-972-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB0241291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice