Healthcare Provider Details

I. General information

NPI: 1689366536
Provider Name (Legal Business Name): KATHERINE CECILE STUARDI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2663 SANDY PLAINS RD
MARIETTA GA
30066-4256
US

IV. Provider business mailing address

2663 SANDY PLAINS RD
MARIETTA GA
30066-4256
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-0827
  • Fax:
Mailing address:
  • Phone: 770-977-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number124306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: