Provider Demographics
NPI:1912918863
Name:SHOFLICK, STUART M
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:M
Last Name:SHOFLICK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:M
Other - Last Name:SHOFLICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:22 BUCKINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2757
Mailing Address - Country:US
Mailing Address - Phone:860-231-8144
Mailing Address - Fax:
Practice Address - Street 1:2139 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2336
Practice Address - Country:US
Practice Address - Phone:860-529-0624
Practice Address - Fax:860-721-0407
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice