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General NPI Number Information
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NPI Number | 1912258740
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Entity Type | Organization
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Legal Business Name | STONE ORAL FACIAL SURGERY GROUP PLLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 2550 ELKTON TRL
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City | TYLER
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State | TX
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Zip | 75703-0594
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Country | US
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Telephone | 903-534-1414
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Fax | 903-534-1415
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Provider Business Mailing Address
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Address Line | 2550 ELKTON TRL
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City | TYLER
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State | TX
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Zip | 75703-0594
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Country | US
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Telephone | 903-534-1414
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Fax | 903-534-1415
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Authorized Official
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Title or Position | OWNER/OFFICER
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Name | DR. CHARLES G STONE JR.
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Credential | DDS
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Telephone | 903-534-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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