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NPI Code Detail

MEDICARE: CORNERSTONE DENTISTRY HOLDINGS PLLC

MEDICARE: CORNERSTONE DENTISTRY HOLDINGS PLLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1710499538
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORNERSTONE DENTISTRY HOLDINGS PLLC
Provider Business Mailing Address
First Line : PO BOX 70887
Second Line :
City : CLEVELAND
State : OH
Zip : 44190-0887
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 E MERRITT ISLAND CSWY STE 105
Second Line :
City : MERRITT ISLAND
State : FL
Zip : 32952-3514
Country : US
Telephone Number : 321-453-8882
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JERE GILLAN
Credential :
Telephone Number : 321-453-8882
Provider Enumeration Date : 11/02/2017
Last Update Date : 06/20/2023

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Directions to “CORNERSTONE DENTISTRY HOLDINGS PLLC ” Practice Location

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