Provider Demographics
NPI:1972011161
Name:STONE, MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
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 1:77 BEACON STREET
Mailing Address - Street 2:OR 1ST FL OFFICE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-3421
Mailing Address - Country:US
Mailing Address - Phone:617-367-0067
Mailing Address - Fax:
Practice Address - Street 1:77 BEACON STREET
Practice Address - Street 2:OR 1ST FL OFFICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3421
Practice Address - Country:US
Practice Address - Phone:617-367-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN125731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice