Provider Demographics
NPI:1821139569
Name:STONE, ELLEN HILLARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:HILLARY
Last Name:STONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:MORDUJOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2825 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-453-0123
Mailing Address - Fax:310-453-0130
Practice Address - Street 1:2825 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-0123
Practice Address - Fax:310-453-0130
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry