Organization
STONE MOUNTAIN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCHADALE STEVENS D.D.S. (PRESIDENT)
(404) 292-8383
Entity
Organization
Contact information
Practice address
4813 ROCKBRIDGE RD STE 26, STONE MOUNTAIN, GA 30083-4200
(404) 292-8383
(404) 292-8344
Mailing address
4813 ROCKBRIDGE RD STE 26, STONE MOUNTAIN, GA 30083-4200
(404) 292-8383
(404) 292-8344
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
012150
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00090964A
—
GA
Enumeration date
10/24/2008
Last updated
10/24/2008
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