Provider Demographics
NPI:1619181054
Name:STONE, DAVID MARK (DMD,DSCD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:STONE
Suffix:
Gender:M
Credentials:DMD,DSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HERITAGE MALL
Mailing Address - Street 2:P.O. BOX 258
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-0258
Mailing Address - Country:US
Mailing Address - Phone:978-562-7964
Mailing Address - Fax:978-562-8914
Practice Address - Street 1:1 HERITAGE MALL
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-0258
Practice Address - Country:US
Practice Address - Phone:978-562-7964
Practice Address - Fax:978-562-8914
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics