Healthcare Provider Details

I. General information

NPI: 1053330985
Provider Name (Legal Business Name): STUART V. CORSO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MOUNTAIN VIEW DR.
DANVILLE VT
05828
US

IV. Provider business mailing address

PO BOX 230
DANVILLE VT
05828-0230
US

V. Phone/Fax

Practice location:
  • Phone: 802-684-1133
  • Fax: 802-684-1138
Mailing address:
  • Phone: 802-684-1133
  • Fax: 802-684-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016-0001005
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: