Provider Demographics
NPI:1083607188
Name:STONE, JUSTIN HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:HOWARD
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 1:110 BERGEN ST
Mailing Address - Street 2:RECEPTION AREA 8
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-7040
Mailing Address - Fax:973-972-0097
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:RECEPTION AREA 8
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-7040
Practice Address - Fax:973-972-0097
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ61551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0535303Medicaid