MEDICARE: DR. MARK F STONER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12010013A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9659	OTHER	IN	PHP NUMBER

General Provider Information

NPI Number	:	1285769299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK F STONER D.D.S.

Provider Business Mailing Address
First Line	:	4116 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6911
Country	:	US
Telephone Number	:	260-485-8118
Fax Number	:	260-482-3750

Provider Business Practice Location Address
First Line	:	4116 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6911
Country	:	US
Telephone Number	:	260-485-8118
Fax Number	:	260-482-3750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/09/2007

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