Provider Demographics
NPI:1578676011
Name:ATKINSON, STUART LELAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LELAND
Last Name:ATKINSON
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 1:2321 JOHN HAWKINS PKWY
Mailing Address - Street 2:221
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3540
Mailing Address - Country:US
Mailing Address - Phone:205-989-5889
Mailing Address - Fax:205-989-6585
Practice Address - Street 1:2321 JOHN HAWKINS PKWY
Practice Address - Street 2:221
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3540
Practice Address - Country:US
Practice Address - Phone:205-989-5889
Practice Address - Fax:205-989-6585
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL917616Medicare UPIN
AL51098705Medicare UPIN