Provider Demographics
NPI:1053649459
Name:CORNERSTONE DENTAL
Entity Type:Organization
Organization Name:CORNERSTONE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-448-7828
Mailing Address - Street 1:4009 TAMPA RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3206
Mailing Address - Country:US
Mailing Address - Phone:813-448-7828
Mailing Address - Fax:
Practice Address - Street 1:4009 TAMPA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3206
Practice Address - Country:US
Practice Address - Phone:813-448-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL119751223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty