Provider Demographics
NPI:1023373800
Name:CARL R. STONECIPHER DDS
Entity Type:Organization
Organization Name:CARL R. STONECIPHER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:STONECIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-348-0831
Mailing Address - Street 1:2800 JACKSON BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1504
Mailing Address - Country:US
Mailing Address - Phone:605-348-0831
Mailing Address - Fax:605-348-0602
Practice Address - Street 1:2800 JACKSON BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1504
Practice Address - Country:US
Practice Address - Phone:605-348-0831
Practice Address - Fax:605-348-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM3981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty