Provider Demographics
NPI:1043749062
Name:STUART, JONATHAN A (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:STUART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 BUSINESS ONE CIR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-9526
Mailing Address - Country:US
Mailing Address - Phone:509-525-4662
Mailing Address - Fax:509-525-0513
Practice Address - Street 1:213 W G ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3227
Practice Address - Country:US
Practice Address - Phone:909-986-6180
Practice Address - Fax:909-986-6179
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031491223G0001X
WADE607747941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice