Provider Demographics
NPI:1558417006
Name:STONE, DALE LEONARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:LEONARD
Last Name:STONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 VICKERY ST
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553
Mailing Address - Country:US
Mailing Address - Phone:706-356-8212
Mailing Address - Fax:706-356-8083
Practice Address - Street 1:5771 VICKERY ST
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553
Practice Address - Country:US
Practice Address - Phone:706-356-8212
Practice Address - Fax:706-356-8083
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000137849AMedicaid