MEDICARE: DR. STUART V. CORSO D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	016-0001005	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053330985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART V. CORSO D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 230
Second Line	:
City	:	DANVILLE
State	:	VT
Zip	:	05828-0230
Country	:	US
Telephone Number	:	802-684-1133
Fax Number	:	802-684-1138

Provider Business Practice Location Address
First Line	:	31 MOUNTAIN VIEW DR.
Second Line	:
City	:	DANVILLE
State	:	VT
Zip	:	05828
Country	:	US
Telephone Number	:	802-684-1133
Fax Number	:	802-684-1138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/09/2007

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