Provider Demographics
NPI:1487887741
Name:LUCAS STONER, TINA SUE (DMD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:SUE
Last Name:LUCAS STONER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28435 W ARAPAHO AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MO
Mailing Address - Zip Code:63435-2067
Mailing Address - Country:US
Mailing Address - Phone:217-653-2781
Mailing Address - Fax:
Practice Address - Street 1:28435 W ARAPAHO AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MO
Practice Address - Zip Code:63435-2067
Practice Address - Country:US
Practice Address - Phone:217-653-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190281291223G0001X
MO20200099251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice