Provider Demographics
NPI:1205849437
Name:STUART W ERWIN DMD PC
Entity Type:Organization
Organization Name:STUART W ERWIN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:WENDEL
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-283-8190
Mailing Address - Street 1:22 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1818
Mailing Address - Country:US
Mailing Address - Phone:706-283-8190
Mailing Address - Fax:709-283-1090
Practice Address - Street 1:22 LAUREL DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1818
Practice Address - Country:US
Practice Address - Phone:706-283-8190
Practice Address - Fax:709-283-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00157242AMedicaid