Provider Demographics
NPI:1699142513
Name:STONE RIDGE DENTAL
Entity type:Organization
Organization Name:STONE RIDGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-403-0555
Mailing Address - Street 1:19375 STONE OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3247
Mailing Address - Country:US
Mailing Address - Phone:210-403-0555
Mailing Address - Fax:210-403-9876
Practice Address - Street 1:19375 STONE OAK PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3247
Practice Address - Country:US
Practice Address - Phone:210-403-0555
Practice Address - Fax:210-403-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty