Provider Demographics
NPI:1619852423
Name:KINGDOM DENTAL CARE
Entity type:Organization
Organization Name:KINGDOM DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUROSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-204-3651
Mailing Address - Street 1:804 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-1709
Mailing Address - Country:US
Mailing Address - Phone:319-444-3343
Mailing Address - Fax:319-444-2607
Practice Address - Street 1:804 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-1709
Practice Address - Country:US
Practice Address - Phone:319-444-3343
Practice Address - Fax:319-444-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental