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Organization
CRANIOFACIAL, RECONSTRUCTIVE AND COSMETIC SURGERY ASSOCIATES, LLC
Active
Organization
CRANIOFACIAL, RECONSTRUCTIVE AND COSMETIC SURGERY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STONE R THAYER DMD, MD (PRESIDENT)
(786) 471-4299
Entity
Organization
Contact information
Practice address
6705 SW 57TH AVE STE 510, SOUTH MIAMI, FL 33143-3644
(786) 471-4299
Mailing address
1949 ISLA DE PALMA CIR, NAPLES, FL 34119-3403
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
ME114524
FL
208D00000X
General Practice Physician
ME114524
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
01/31/2014
Last updated
01/24/2015
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