Provider Demographics
NPI:1871096123
Name:STUART M. SHOFLICK, DMD, PLLC
Entity type:Organization
Organization Name:STUART M. SHOFLICK, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHOFLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-508-3467
Mailing Address - Street 1:155 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3450
Mailing Address - Country:US
Mailing Address - Phone:860-236-5455
Mailing Address - Fax:888-247-6762
Practice Address - Street 1:155 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3450
Practice Address - Country:US
Practice Address - Phone:860-236-5455
Practice Address - Fax:888-247-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty