Provider Demographics
NPI:1043298300
Name:STUART, MARY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:STUART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 OLD NORTH RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01098-9753
Mailing Address - Country:US
Mailing Address - Phone:413-238-5511
Mailing Address - Fax:413-238-5570
Practice Address - Street 1:58 OLD NORTH RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MA
Practice Address - Zip Code:01098-9753
Practice Address - Country:US
Practice Address - Phone:413-238-5511
Practice Address - Fax:413-238-5570
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice