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General NPI Number Information
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NPI Number | 1477870665
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Entity Type | Organization
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Legal Business Name | FREDRICK EDWIN STUART DDS, INC.
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 8781 VAN NUYS BLVD FL 2
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City | PANORAMA CITY
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State | CA
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Zip | 91402-2401
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Country | US
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Telephone | 818-893-2716
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Fax | 818-994-4117
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Provider Business Mailing Address
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Address Line | 8781 VAN NUYS BLVD FL 2
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City | PANORAMA CITY
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State | CA
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Zip | 91402-2401
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Country | US
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Telephone | 818-893-2716
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Fax | 818-994-4117
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Authorized Official
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Title or Position | MANAGER
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Name | DIANA RODRIGUEZ
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Credential |
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Telephone | 213-842-0538
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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 | 24875
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License Number State | CA
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