MEDICARE: DR. IRA STONE DMD

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	12214	FL

General Provider Information

NPI Number	:	1811022858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA STONE DMD

Provider Business Mailing Address
First Line	:	4420 SHERIDAN ST STE B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3552
Country	:	US
Telephone Number	:	954-981-4896
Fax Number	:	954-981-1523

Provider Business Practice Location Address
First Line	:	4420 SHERIDAN ST STE B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3552
Country	:	US
Telephone Number	:	954-981-4896
Fax Number	:	954-981-1523

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	04/04/2016

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