Provider Demographics
NPI:1104436369
Name:STONE, ALTON MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ALTON
Middle Name:MICHAEL
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 1:3170 CLEARMONT RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8334
Mailing Address - Country:US
Mailing Address - Phone:850-272-3508
Mailing Address - Fax:
Practice Address - Street 1:3015 JEFFERSON ST STE D
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2300
Practice Address - Country:US
Practice Address - Phone:850-526-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty