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NPI Code Detail

MEDICARE: ROBERT STUTTS III DMD

MEDICARE: ROBERT STUTTS III DMD
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
11223G0001XGeneral Practice Dentistry52535NY

Other Identifiers

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

General Provider Information

NPI Number : 1801811807
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT STUTTS III DMD
Provider Business Mailing Address
First Line : 55 E MOSHOLU PKWY N
Second Line :
City : BRONX
State : NY
Zip : 10467-2625
Country : US
Telephone Number : 718-652-7370
Fax Number : 718-882-5650
Provider Business Practice Location Address
First Line : 55 E MOSHOLU PKWY N
Second Line :
City : BRONX
State : NY
Zip : 10467-2625
Country : US
Telephone Number : 718-652-7370
Fax Number : 718-882-5650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 07/08/2007

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