Provider Demographics
NPI:1447247515
Name:STUART, GORDON EDGAR (DDS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:EDGAR
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 1:6182 HOWDERSHELL RD
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1170
Mailing Address - Country:US
Mailing Address - Phone:314-731-2666
Mailing Address - Fax:314-731-2666
Practice Address - Street 1:6182 HOWDERSHELL RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1170
Practice Address - Country:US
Practice Address - Phone:314-731-2666
Practice Address - Fax:314-731-2666
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0129391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice