Provider Demographics
NPI:1356600332
Name:STONEGATE DENTAL CARE PC
Entity type:Organization
Organization Name:STONEGATE DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-851-7069
Mailing Address - Street 1:17021 LINCOLN AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:720-851-7069
Mailing Address - Fax:
Practice Address - Street 1:17021 LINCOLN AVE
Practice Address - Street 2:UNIT B
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:720-851-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty