Provider Demographics
NPI:1689022840
Name:STONE, TODD (DMD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
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 1:151 WESTCHESTER HL
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8711
Mailing Address - Country:US
Mailing Address - Phone:631-444-2557
Mailing Address - Fax:631-444-6013
Practice Address - Street 1:151 WESTCHESTER HL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8711
Practice Address - Country:US
Practice Address - Phone:631-444-2557
Practice Address - Fax:631-444-6013
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIDT-30491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program