Provider Demographics
NPI:1073891446
Name:3 STONE DENTAL
Entity Type:Organization
Organization Name:3 STONE DENTAL
Other - Org Name:WESTGATE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS/FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTA MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-444-9345
Mailing Address - Street 1:911 CENTRAL AVE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1350
Mailing Address - Country:US
Mailing Address - Phone:518-689-0100
Mailing Address - Fax:518-689-0109
Practice Address - Street 1:911 CENTRAL AVE
Practice Address - Street 2:SUITE B4
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1350
Practice Address - Country:US
Practice Address - Phone:518-689-0100
Practice Address - Fax:518-689-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051925OtherSTATE DENTAL LICENSE
NY055515-1OtherSTATE DENTAL LICENSE