Healthcare Provider Details

I. General information

NPI: 1932758992
Provider Name (Legal Business Name): STONEDENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 PAN AMERICAN DR STE 4
HARKER HEIGHTS TX
76548-1960
US

IV. Provider business mailing address

9116 WOLF CREEK DR
WACO TX
76712-8738
US

V. Phone/Fax

Practice location:
  • Phone: 254-680-5551
  • Fax: 254-754-0907
Mailing address:
  • Phone: 254-855-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDY ADAMO
Title or Position: OWNER
Credential:
Phone: 254-855-9652