Provider Demographics
NPI:1598857849
Name:KENNETH E STONER DDS., FAMILY DENTISTRY
Entity Type:Organization
Organization Name:KENNETH E STONER DDS., FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-743-3490
Mailing Address - Street 1:4106A MEADOWDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5503
Mailing Address - Country:US
Mailing Address - Phone:804-743-3490
Mailing Address - Fax:804-743-3490
Practice Address - Street 1:4106A MEADOWDALE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5503
Practice Address - Country:US
Practice Address - Phone:804-743-3491
Practice Address - Fax:804-743-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7802056Medicaid