Provider Demographics
NPI:1750909297
Name:AMICK, STUART DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:DAVID
Last Name:AMICK
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 1:510 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47977-8883
Mailing Address - Country:US
Mailing Address - Phone:219-261-2217
Mailing Address - Fax:
Practice Address - Street 1:510 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47977-8883
Practice Address - Country:US
Practice Address - Phone:219-261-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013426A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice