Healthcare Provider Details

I. General information

NPI: 1437447430
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF STUART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SE COCONUT AVE
STUART FL
34996-2547
US

IV. Provider business mailing address

413 SE COCONUT AVE
STUART FL
34996-2547
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-1230
  • Fax: 772-283-1325
Mailing address:
  • Phone: 772-283-1230
  • Fax: 772-283-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN10845
License Number StateFL

VIII. Authorized Official

Name: DR. NANCY HELEN TORRES
Title or Position: PRESIDENT/PEDIATRIC DENTIST
Credential: D.D.S.
Phone: 772-283-1230