Provider Demographics
NPI:1164806881
Name:STONE, SHAINA (DMD)
Entity Type:Individual
Prefix:MS
First Name:SHAINA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:HYNDMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15545-0706
Mailing Address - Country:US
Mailing Address - Phone:814-842-3206
Mailing Address - Fax:
Practice Address - Street 1:144 5TH AVE
Practice Address - Street 2:
Practice Address - City:HYNDMAN
Practice Address - State:PA
Practice Address - Zip Code:15545-7379
Practice Address - Country:US
Practice Address - Phone:814-842-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040411122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103416537Medicaid