Provider Demographics
NPI:1811214307
Name:ROGER L. STUART
Entity Type:Organization
Organization Name:ROGER L. STUART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-574-3985
Mailing Address - Street 1:14313 NE 20TH AVE
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1487
Mailing Address - Country:US
Mailing Address - Phone:360-574-3985
Mailing Address - Fax:360-574-0452
Practice Address - Street 1:14313 NE 20TH AVE
Practice Address - Street 2:SUITE A-101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1487
Practice Address - Country:US
Practice Address - Phone:360-574-3985
Practice Address - Fax:360-574-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty