Provider Demographics
NPI:1720524747
Name:STONEHAVEN DENTAL - MIDVALE, LLC
Entity type:Organization
Organization Name:STONEHAVEN DENTAL - MIDVALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8500
Mailing Address - Street 1:7681 S 700 E
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2350
Mailing Address - Country:US
Mailing Address - Phone:385-557-0088
Mailing Address - Fax:385-351-1558
Practice Address - Street 1:7681 S 700 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2350
Practice Address - Country:US
Practice Address - Phone:385-385-5570
Practice Address - Fax:385-385-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-14
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty