Healthcare Provider Details

I. General information

NPI: 1356303580
Provider Name (Legal Business Name): GARY W. STONE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 9900, 2D FLOOR HQS, USA DENTAC, FT LEWIS
TACOMA WA
98431
US

IV. Provider business mailing address

BLDG 9900, 2D FLOOR HQS, USA DENTAC, FT LEWIS
TACOMA WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4039
  • Fax:
Mailing address:
  • Phone: 253-968-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: