Provider Demographics
NPI: | 1053613257 |
---|---|
Name: | CORNERSTONE ONSITE, LLC |
Entity type: | Organization |
Organization Name: | CORNERSTONE ONSITE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | HARVEY |
Authorized Official - Last Name: | COLEMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 713-227-6453 |
Mailing Address - Street 1: | 7575 SAN FELIPE ST |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77063-1711 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-227-6453 |
Mailing Address - Fax: | 185-582-7744 |
Practice Address - Street 1: | 7575 SAN FELIPE ST |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77063-1711 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-227-6453 |
Practice Address - Fax: | 855-827-7442 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-11-22 |
Last Update Date: | 2016-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 14296 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |