Provider Demographics
NPI:1831268374
Name:STONE DENTAL CLINIC
Entity type:Organization
Organization Name:STONE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:COURNTEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-928-7901
Mailing Address - Street 1:134 CRITZ ST N
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-3216
Mailing Address - Country:US
Mailing Address - Phone:601-928-7901
Mailing Address - Fax:601-928-2373
Practice Address - Street 1:134 CRITZ ST N
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-3216
Practice Address - Country:US
Practice Address - Phone:601-928-7901
Practice Address - Fax:601-928-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1357-69122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060560Medicaid