Provider Demographics
NPI:1023078284
Name:STUART, CHARLES HILLAM (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:HILLAM
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 1:6249 BRISA DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1854
Mailing Address - Country:US
Mailing Address - Phone:915-832-0592
Mailing Address - Fax:
Practice Address - Street 1:7211 N MESA ST STE 2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3611
Practice Address - Country:US
Practice Address - Phone:915-581-3391
Practice Address - Fax:915-581-4825
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4789791-99211223E0200X
TX227061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics