Individual
KENNETH JOSEPH STUART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2344 N MERRIT CRK LOOP, COEUR D ALENE, ID 83814-4950
(208) 512-4130
Mailing address
2344 N MERRIT CRK LOOP, COEUR D ALENE, ID 83814-4950
(208) 512-4130
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5554
ID
1223G0001X
General Practice Dentistry
S15-692-135
KY
Other
Enumeration date
06/06/2018
Last updated
08/08/2023
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