Provider Demographics
NPI:1922566801
Name:CORNERSTONE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-624-0222
Mailing Address - Street 1:1325 S SANGRE RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1854
Mailing Address - Country:US
Mailing Address - Phone:405-624-0222
Mailing Address - Fax:405-624-6003
Practice Address - Street 1:1325 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1854
Practice Address - Country:US
Practice Address - Phone:405-624-0222
Practice Address - Fax:405-624-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty