Stone Oral Facial Surgery Group PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

STONE ORAL FACIAL SURGERY GROUP PLLC

Doing business as

Southern Surgical Arts

Practice address

2550 Elkton TRL
Tyler, TX 75703-0594

Phone

(903) 534-1414

Fax

(903) 534-1415

NPI assigned

Sep 19, 2012

Last updated

Dec 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles G Stone Jr., DDSNPI 1841219342

Title

Owner/Officer

Phone

(903) 534-1414

Specialties & licenses 1

Addresses

Other identifiers 10

Other names 1

• Southern Surgical Arts Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Glenn Stone Jr., DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Tyler, TX
  • NPI 1841219342
  Medicare reassignment Care Compare group NPD Authorized official
• Wade Ryan Barker, DDS MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Tyler, TX
  • NPI 1740612084
  Medicare reassignment Care Compare group NPD
• Brian Henry Stone, D.D.S., M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Tyler, TX
  • NPI 1265650071
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388016000000",
    "number": "1912258740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 ELKTON TRL",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030594",
            "telephone_number": "903-534-1414",
            "fax_number": "903-534-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 ELKTON TRL",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030594",
            "telephone_number": "903-534-1414",
            "fax_number": "903-534-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONE ORAL FACIAL SURGERY GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2013-12-26",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/OFFICER",
        "authorized_official_telephone_number": "903-534-1414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1305898-08",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2032740-07",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1206989-09",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2032740-06",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3126690-03",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1206989-08",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1305898-09",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1896953-05",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1896953-06",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3099020-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Surgical Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Stine
• Alexander Stock, MD
• James Martin Stocks, MD
• Victoria Stokes
• Melissa Stolsworth
• Brian Henry Stone, D.D.S., M.D.
• Charles Glenn Stone Jr., DDS
• Lindsey Stone
• Amanda Storer, PTA
• Nicholas Ryan Storey, MD

• Oral and Maxillofacial Surgery (Dentist) in Tyler, TX
• Providers in Tyler, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.