Provider Demographics
NPI:1053330985
Name:CORSO, STUART V (DMD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:V
Last Name:CORSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05828-0230
Mailing Address - Country:US
Mailing Address - Phone:802-684-1133
Mailing Address - Fax:802-684-1138
Practice Address - Street 1:31 MOUNTAIN VIEW DR.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:05828
Practice Address - Country:US
Practice Address - Phone:802-684-1133
Practice Address - Fax:802-684-1138
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00010051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001654Medicaid