Healthcare Provider Details

I. General information

NPI: 1871189860
Provider Name (Legal Business Name): STONE THAYER MD, DMD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W WASHINGTON ST STE 1
SAN DIEGO CA
92103-1873
US

IV. Provider business mailing address

1000 W WASHINGTON ST STE 1
SAN DIEGO CA
92103-1873
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: STONE THAYER
Title or Position: OWNER
Credential: MD
Phone: 657-284-2178