Provider Demographics
NPI:1447793229
Name:STONE GLEN DENTAL CARE PLLC
Entity Type:Organization
Organization Name:STONE GLEN DENTAL CARE PLLC
Other - Org Name:FRANCIS HOANG STONE GLEN DENTAL CARE, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH-XUAN
Authorized Official - Middle Name:BUI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-482-1400
Mailing Address - Street 1:4400 HERITAGE TRACE PKWY
Mailing Address - Street 2:STE 212
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8901
Mailing Address - Country:US
Mailing Address - Phone:817-482-1400
Mailing Address - Fax:
Practice Address - Street 1:4400 HERITAGE TRACE PKWY
Practice Address - Street 2:STE 212
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8901
Practice Address - Country:US
Practice Address - Phone:817-482-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONE GLEN DENTAL CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty