Provider Demographics
NPI:1639733389
Name:STONE GATE DENTAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:STONE GATE DENTAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-250-5540
Mailing Address - Street 1:1521 NORTHWAY DR STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4490
Mailing Address - Country:US
Mailing Address - Phone:320-250-5540
Mailing Address - Fax:
Practice Address - Street 1:1521 NORTHWAY DR STE 108
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4490
Practice Address - Country:US
Practice Address - Phone:320-250-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental