Provider Demographics
NPI:1467213496
Name:STONECREST DENTURE CENTER
Entity Type:Organization
Organization Name:STONECREST DENTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASSIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-676-7712
Mailing Address - Street 1:7445 COVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-7664
Mailing Address - Country:US
Mailing Address - Phone:770-676-7712
Mailing Address - Fax:470-545-1064
Practice Address - Street 1:7445 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7664
Practice Address - Country:US
Practice Address - Phone:770-676-7712
Practice Address - Fax:470-545-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental