Provider Demographics
NPI:1811080930
Name:STUART, KATHRYN G (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:G
Last Name:STUART
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E 116TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3508
Mailing Address - Country:US
Mailing Address - Phone:317-848-7778
Mailing Address - Fax:
Practice Address - Street 1:2000 E 116TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3508
Practice Address - Country:US
Practice Address - Phone:317-848-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120085001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics