Provider Demographics
NPI:1184041048
Name:CORNERSTONE DENTAL STAFFING LLC
Entity Type:Organization
Organization Name:CORNERSTONE DENTAL STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HUSSONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-984-6001
Mailing Address - Street 1:1010 S 3RD ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-1181
Mailing Address - Country:US
Mailing Address - Phone:515-984-6001
Mailing Address - Fax:515-984-6707
Practice Address - Street 1:1010 S 3RD ST STE 2A
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-1181
Practice Address - Country:US
Practice Address - Phone:515-984-6001
Practice Address - Fax:515-984-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental