MEDICARE: WILLIAM R STUART DMD PA

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	1968	SC

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	:	1922268184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM R STUART DMD PA

Provider Business Mailing Address
First Line	:	2131 WOODRUFF ROAD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607
Country	:	US
Telephone Number	:	864-288-8388
Fax Number	:	864-288-8038

Provider Business Practice Location Address
First Line	:	2131 WOODRUFF ROAD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607
Country	:	US
Telephone Number	:	864-288-8388
Fax Number	:	864-288-8038

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM R STUART
Credential	:	DMD
Telephone Number	:	864-288-8388

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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