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General NPI Number Information
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NPI Number | 1043749062
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Entity Type | Individual
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Provider Name | JONATHAN A STUART DDS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 213 W G ST
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City | ONTARIO
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State | CA
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Zip | 91762-3227
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Country | US
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Telephone | 909-986-6180
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Fax | 909-986-6179
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Provider Business Mailing Address
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Address Line | 1545 BUSINESS ONE CIR
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City | WALLA WALLA
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State | WA
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Zip | 99362-9526
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Country | US
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Telephone | 509-525-4662
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Fax | 509-525-0513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103149
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60774794
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License Number State | WA
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