Provider Demographics
NPI:1386980993
Name:CORNERSTONE DENTAL
Entity type:Organization
Organization Name:CORNERSTONE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OEHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-365-3333
Mailing Address - Street 1:12000 US HIGHWAY 380
Mailing Address - Street 2:STE 114
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2339
Mailing Address - Country:US
Mailing Address - Phone:940-365-3333
Mailing Address - Fax:940-365-3886
Practice Address - Street 1:12000 US HIGHWAY 380
Practice Address - Street 2:STE 114
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2339
Practice Address - Country:US
Practice Address - Phone:940-365-3333
Practice Address - Fax:940-365-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty