Healthcare Provider Details

I. General information

NPI: 1053568808
Provider Name (Legal Business Name): HOWARD ARCH STONE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2008
Last Update Date: 08/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E ASHLAND AVE
MT ZION IL
62549-1271
US

IV. Provider business mailing address

2405 ANGLE CT
DECATUR IL
62521-4601
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-2108
  • Fax:
Mailing address:
  • Phone: 217-429-1749
  • Fax: 217-864-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019010386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: