Organization
STONE ORAL FACIAL SURGERY GROUP PLLC
Active
Other names
Southern Surgical Arts
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES G STONE JR. DDS (OWNER/OFFICER)
(903) 534-1414
Entity
Organization
Contact information
Practice address
2550 ELKTON TRL, TYLER, TX 75703-0594
(903) 534-1414
(903) 534-1415
Mailing address
2550 ELKTON TRL, TYLER, TX 75703-0594
(903) 534-1414
(903) 534-1415
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1206989-08
—
TX
05
—
1206989-09
—
TX
05
—
1305898-08
—
TX
05
—
1305898-09
—
TX
05
—
1896953-05
—
TX
05
—
1896953-06
—
TX
05
—
2032740-06
—
TX
05
—
2032740-07
—
TX
05
—
3099020-01
—
TX
05
—
3126690-03
—
TX
Enumeration date
09/19/2012
Last updated
12/26/2013
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