Provider Demographics
NPI:1588985899
Name:STONE, MONA M (DDS)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:M
Last Name:STONE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:KALAYEH
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 ANDORRA DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:817-918-3666
Mailing Address - Fax:
Practice Address - Street 1:72 ANDORRA DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WESTLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-8649
Practice Address - Country:US
Practice Address - Phone:817-918-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324361223S0112X, 204E00000X, 1223S0112X
PADS0403041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA814258947Medicaid