Provider Demographics
NPI:1235171059
Name:FLACK & STONE, D.D.S., P.C.
Entity Type:Organization
Organization Name:FLACK & STONE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-229-3737
Mailing Address - Street 1:300 W R D MIZE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2528
Mailing Address - Country:US
Mailing Address - Phone:816-229-3737
Mailing Address - Fax:816-229-1656
Practice Address - Street 1:300 W R D MIZE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2528
Practice Address - Country:US
Practice Address - Phone:816-229-3737
Practice Address - Fax:816-229-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO127001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOOTHOOOMedicare UPIN