Provider Demographics
NPI:1760482392
Name:HERSEY, STUART G (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:G
Last Name:HERSEY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11201 88TH AVE E SUITE 120
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373
Mailing Address - Country:US
Mailing Address - Phone:253-864-9889
Mailing Address - Fax:253-841-6331
Practice Address - Street 1:11201 88TH AVE E SUITE 120
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373
Practice Address - Country:US
Practice Address - Phone:253-864-9889
Practice Address - Fax:253-841-6331
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA72671223P0221X
WADE72671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry