Provider Demographics
NPI:1679695696
Name:NUNNALLY, STUART MATERN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:MATERN
Last Name:NUNNALLY
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 1:2100 FM 1431
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4704
Mailing Address - Country:US
Mailing Address - Phone:830-693-3646
Mailing Address - Fax:830-693-4061
Practice Address - Street 1:2100 FM 1431
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4704
Practice Address - Country:US
Practice Address - Phone:830-693-3646
Practice Address - Fax:830-693-4061
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice