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General NPI Number Information
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NPI Number | 1073016028
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Entity Type | Individual
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Provider Name | STUART W ALLYN DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 805 S RESERVE ST, MISSOULA, MT
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City | MISSOULA
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State | MT
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Zip | 59801
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Country | US
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Telephone | 406-549-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 805 S RESERVE ST, MISSOULA, MT 59801
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City | MISSOULA
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State | MT
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Zip | 59801
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Country | US
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Telephone |
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN-DEN-LIC-28338
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 144637
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License Number State | MT
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