Provider Demographics
NPI:1710145446
Name:STOKES MOUNTAIN DENTAL GROUP, PC
Entity Type:Organization
Organization Name:STOKES MOUNTAIN DENTAL GROUP, PC
Other - Org Name:MOUNTAIN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:F
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-433-5355
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:9285 S CIMARRON RD
Practice Address - Street 2:SUITE 125
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-2503
Practice Address - Country:US
Practice Address - Phone:702-433-5355
Practice Address - Fax:702-360-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty