Provider Demographics
NPI:1386260644
Name:CORNERSTONE DENTAL CENTER
Entity type:Organization
Organization Name:CORNERSTONE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-772-5141
Mailing Address - Street 1:8385 N CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8684
Mailing Address - Country:US
Mailing Address - Phone:208-772-5141
Mailing Address - Fax:
Practice Address - Street 1:8385 N CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8684
Practice Address - Country:US
Practice Address - Phone:208-772-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental