Healthcare Provider Details

I. General information

NPI: 1881852424
Provider Name (Legal Business Name): STUART V CORSO DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MOUNTAIN VIEW DR
DANVILLE VT
05828-9642
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 Number0160001005
License Number StateVT

VIII. Authorized Official

Name: DR. STUART V CORSO
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 802-684-1133