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General NPI Number Information
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NPI Number | 1255946984
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Entity Type | Organization
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Legal Business Name | STONEHAVEN DENTAL BURLESON PLLC
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 225 E RENFRO ST STE 109
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City | BURLESON
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State | TX
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Zip | 76028-3916
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Country | US
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Telephone | 817-259-1828
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Fax | 817-259-1829
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Provider Business Mailing Address
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Address Line | 225 E RENFRO ST STE 109
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City | BURLESON
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State | TX
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Zip | 76028-3916
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Country | US
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Telephone | 817-259-1828
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Fax | 817-259-1829
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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