Provider Demographics
NPI:1437187143
Name:GRISWOLD, STUART LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LEE
Last Name:GRISWOLD
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 1:303 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-2305
Mailing Address - Country:US
Mailing Address - Phone:205-932-5290
Mailing Address - Fax:205-932-5290
Practice Address - Street 1:303 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-2305
Practice Address - Country:US
Practice Address - Phone:205-932-5290
Practice Address - Fax:205-932-5290
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice