Provider Demographics
NPI:1336358654
Name:STONEYBROOK DENTAL, P.C.
Entity Type:Organization
Organization Name:STONEYBROOK DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:LEONOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-476-0383
Mailing Address - Street 1:23020 POWER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3226
Mailing Address - Country:US
Mailing Address - Phone:248-476-0383
Mailing Address - Fax:248-476-1191
Practice Address - Street 1:23020 POWER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3226
Practice Address - Country:US
Practice Address - Phone:248-476-0383
Practice Address - Fax:248-476-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI148301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty