1386980993 NPI number — CORNERSTONE DENTAL

Table of content: CAROLE MONEREAU SMART RN (NPI 1619244738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386980993 NPI number — CORNERSTONE DENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE DENTAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386980993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12000 US HIGHWAY 380
Provider Second Line Business Mailing Address:
STE 114
Provider Business Mailing Address City Name:
CROSSROADS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76227-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-365-3333
Provider Business Mailing Address Fax Number:
940-365-3886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12000 US HIGHWAY 380
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
CROSSROADS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76227-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-365-3333
Provider Business Practice Location Address Fax Number:
940-365-3886
Provider Enumeration Date:
12/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OEHLKE
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
940-365-3333

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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