Healthcare Provider Details

I. General information

NPI: 1174361430
Provider Name (Legal Business Name): STUART SMILE DESIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SE 5TH ST
STUART FL
34994-2359
US

IV. Provider business mailing address

931 SE OCEAN BLVD STE B1
STUART FL
34994-2425
US

V. Phone/Fax

Practice location:
  • Phone: 561-252-8558
  • Fax:
Mailing address:
  • Phone: 561-252-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY CRARY
Title or Position: DENTIST
Credential: DMD
Phone: 561-252-8558