Healthcare Provider Details

I. General information

NPI: 1508356221
Provider Name (Legal Business Name): STUART CHRISTIAN MAUGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E ZORA ST
WEBB CITY MO
64870-9770
US

IV. Provider business mailing address

3100 E ZORA ST
WEBB CITY MO
64870-9770
US

V. Phone/Fax

Practice location:
  • Phone: 417-228-8286
  • Fax:
Mailing address:
  • Phone: 417-228-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number62279
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2024020973
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: