Provider Demographics
NPI:1871189860
Name:STONE THAYER MD, DMD, APC
Entity Type:Organization
Organization Name:STONE THAYER MD, DMD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STONE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:657-284-2178
Mailing Address - Street 1:1000 W WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 W WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1873
Practice Address - Country:US
Practice Address - Phone:619-297-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty