Provider Demographics
NPI:1720531171
Name:STONE CANYON DENTAL
Entity type:Organization
Organization Name:STONE CANYON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-226-6655
Mailing Address - Street 1:192 S COLLINS RD
Mailing Address - Street 2:100
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4633
Mailing Address - Country:US
Mailing Address - Phone:972-226-6655
Mailing Address - Fax:
Practice Address - Street 1:192 S COLLINS RD
Practice Address - Street 2:100
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4633
Practice Address - Country:US
Practice Address - Phone:972-226-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30002261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental