Provider Demographics
NPI:1215185095
Name:MCCORMICK, STUART JOHN
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:JOHN
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STUART
Other - Middle Name:JOHN
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5610 MEDICAL CIRCLE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1284
Mailing Address - Country:US
Mailing Address - Phone:608-233-5351
Mailing Address - Fax:608-238-6777
Practice Address - Street 1:5610 MEDICAL CIRCLE
Practice Address - Street 2:SUITE 10
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1284
Practice Address - Country:US
Practice Address - Phone:608-233-5351
Practice Address - Fax:608-238-6777
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist