Provider Demographics
NPI:1285071571
Name:STONECREEK ACQUISITIONS
Entity type:Organization
Organization Name:STONECREEK ACQUISITIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-823-1473
Mailing Address - Street 1:1841 MONTCLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1864
Mailing Address - Country:US
Mailing Address - Phone:205-823-1473
Mailing Address - Fax:
Practice Address - Street 1:1841 MONTCLAIRE LN
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1864
Practice Address - Country:US
Practice Address - Phone:205-823-1473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty