MEDICARE: STONEHAVEN DENTAL-HARKER HEIGHTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1336557057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEHAVEN DENTAL-HARKER HEIGHTS

Provider Business Mailing Address
First Line	:	PO BOX 734753
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-4753
Country	:	US
Telephone Number	:	972-869-3789
Fax Number	:	972-869-3791

Provider Business Practice Location Address
First Line	:	2030 HEIGHTS DR STE 2
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2185
Country	:	US
Telephone Number	:	254-449-9120
Fax Number	:	254-669-7169

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MARY PU
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	04/27/2023

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Directions to “STONEHAVEN DENTAL-HARKER HEIGHTS ” Practice Location

Language	Start Address	Practice Location

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