Provider Demographics
NPI:1952365009
Name:STONE, CHARLES MALCOLM (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MALCOLM
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 1:625 CHERRY TREE LANE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-439-1717
Mailing Address - Fax:724-439-5727
Practice Address - Street 1:625 CHERRY TREE LANE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-439-1717
Practice Address - Fax:724-439-5727
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0181811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery