Healthcare Provider Details

I. General information

NPI: 1487013546
Provider Name (Legal Business Name): PATRICK NEWEL STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 W ARROWHEAD CLUBHOUSE DR #2012
GLENDALE AZ
85308-8841
US

IV. Provider business mailing address

7400 W ARROWHEAD CLUBHOUSE DR #2012
GLENDALE AZ
85308-8841
US

V. Phone/Fax

Practice location:
  • Phone: 208-360-1405
  • Fax:
Mailing address:
  • Phone: 208-360-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9707
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD9707
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: