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Organization
STUART R DOUGLAS DMD PLLC
Active
Organization
STUART R DOUGLAS DMD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STUART R DOUGLAS DMD (OWNER DENTIST)
(607) 753-0602
Entity
Organization
Contact information
Practice address
139 NORTH MAIN ST, CORTLAND, NY 13045
(607) 753-0602
(607) 758-8737
Mailing address
139 NORTH MAIN ST, CORTLAND, NY 13045
(607) 753-0602
(607) 758-8737
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
029842
NY
122300000X
Dentist
052962
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00562652
—
NY
01
—
029842
DELTA
—
Enumeration date
10/04/2006
Last updated
08/22/2020
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