Provider Demographics
NPI:1952069627
Name:KYLE J STUART DMD,PA
Entity Type:Organization
Organization Name:KYLE J STUART DMD,PA
Other - Org Name:KYLE J STUART DMD,PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-463-2665
Mailing Address - Street 1:216 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3427
Mailing Address - Country:US
Mailing Address - Phone:352-463-2665
Mailing Address - Fax:352-463-6848
Practice Address - Street 1:216 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3427
Practice Address - Country:US
Practice Address - Phone:352-463-2665
Practice Address - Fax:352-463-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty