Provider Demographics
NPI:1013032432
Name:STONE, MICHAEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:STONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 BROADWAY STE D
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3065
Mailing Address - Country:US
Mailing Address - Phone:614-875-5559
Mailing Address - Fax:
Practice Address - Street 1:4104 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3065
Practice Address - Country:US
Practice Address - Phone:614-875-5559
Practice Address - Fax:419-782-8880
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306832Medicaid
OH20159OtherLICENSE NUMBER
OH637744OtherUNITED CONCORDIA