Provider Demographics
NPI:1801430608
Name:STONEBRIDGE DENTAL LLC
Entity type:Organization
Organization Name:STONEBRIDGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-235-8234
Mailing Address - Street 1:781 FAR HILLS DR STE 500
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-8448
Mailing Address - Country:US
Mailing Address - Phone:717-235-8234
Mailing Address - Fax:717-235-8266
Practice Address - Street 1:781 FAR HILLS DR STE 500
Practice Address - Street 2:
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-8448
Practice Address - Country:US
Practice Address - Phone:717-235-8234
Practice Address - Fax:717-235-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty