Provider Demographics
NPI:1013758481
Name:STUART, CLINTON BRENT (DDS)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:BRENT
Last Name:STUART
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 1:1000 E CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4115
Mailing Address - Country:US
Mailing Address - Phone:928-257-5238
Mailing Address - Fax:
Practice Address - Street 1:906 S BEELINE HWY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5411
Practice Address - Country:US
Practice Address - Phone:928-472-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-01
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0121741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice