Healthcare Provider Details

I. General information

NPI: 1780080655
Provider Name (Legal Business Name): ROBERT L STUTTS III DMD PAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E WENDOVER AVE STE B
GREENSBORO NC
27401-1227
US

IV. Provider business mailing address

200 E WENDOVER AVE STE B
GREENSBORO NC
27401-1227
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-4583
  • Fax: 336-378-6986
Mailing address:
  • Phone: 336-272-4583
  • Fax: 336-378-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9065
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT LEE STUTTS III
Title or Position: OWNER/SURGEON
Credential: DMD
Phone: 336-272-4583