Healthcare Provider Details

I. General information

NPI: 1861209694
Provider Name (Legal Business Name): STUART ORAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD STE 355
INDIANAPOLIS IN
46260-1987
US

IV. Provider business mailing address

9499 ABERDARE DR
INDIANAPOLIS IN
46250-3406
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-1095
  • Fax:
Mailing address:
  • Phone: 317-752-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD JOSEPH STUART III
Title or Position: OWNER
Credential: DDS
Phone: 317-752-8857