Provider Demographics
NPI:1063633485
Name:WHIDDON, STUART HALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:HALL
Last Name:WHIDDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 GASTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7759
Mailing Address - Country:US
Mailing Address - Phone:336-430-6922
Mailing Address - Fax:
Practice Address - Street 1:3802 GASTON RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7759
Practice Address - Country:US
Practice Address - Phone:336-430-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899203Medicaid