Basic Information
| Provider Information | |||||||||
| NPI: | 1932758992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STONEDENT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9116 WOLF CREEK DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767128738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548559652 | ||||||||
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| Practice Location | |||||||||
| Address1: | 581 PAN AMERICAN DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | HARKER HEIGHTS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765481960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546805551 | ||||||||
| FaxNumber: | 2547540907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2019 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | ADAMO | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2548559652 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.