Basic Information
| Provider Information | |||||||||
| NPI: | 1053613257 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE ONSITE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7575 SAN FELIPE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770631711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132276453 | ||||||||
| FaxNumber: | 1855827744 | ||||||||
| Practice Location | |||||||||
| Address1: | 7575 SAN FELIPE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770631711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132276453 | ||||||||
| FaxNumber: | 8558277442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | HARVEY | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7132276453 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 14296 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.