Provider Demographics
NPI:1427383561
Name:STONE ROAD DENTAL
Entity Type:Organization
Organization Name:STONE ROAD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE PERSONNEL
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-635-4720
Mailing Address - Street 1:2107 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4807
Mailing Address - Country:US
Mailing Address - Phone:716-635-4720
Mailing Address - Fax:716-635-4724
Practice Address - Street 1:2107 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4807
Practice Address - Country:US
Practice Address - Phone:716-635-4720
Practice Address - Fax:716-635-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049459-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty