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General NPI Number Information
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NPI Number | 1326488032
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Entity Type | Organization
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Legal Business Name | STONEBRIAR DENTAL LLP
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 9300 WADE BLVD STE # 230
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City | FRISCO
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State | TX
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Zip | 75035-2174
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Country | US
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Telephone | 972-668-5608
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Fax | 972-668-5611
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Provider Business Mailing Address
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Address Line | 9300 WADE BLVD STE # 230
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City | FRISCO
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State | TX
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Zip | 75035-2174
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Country | US
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Telephone | 972-668-5608
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Fax | 972-668-5611
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. BRIAN H WONG
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Credential | D.D.S
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Telephone | 972-668-5608
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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 | 19418
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19058
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License Number State | TX
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