| Stuart R Douglas Dmd Pllc | |
|
139 North Main St Cortland NY 13045 | |
| (607) 753-0602 | |
| (607) 758-8737 |
| Full Name | Stuart R Douglas Dmd Pllc |
|---|---|
| Speciality | Dentist |
| Location | 139 North Main St, Cortland, New York |
| Authorized Official Name and Position | Stuart R Douglas (OWNER DENTIST) |
| Authorized Official Contact | 6077530602 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stuart R Douglas Dmd Pllc 139 North Main St Cortland NY 13045 Ph: (607) 753-0602 | Stuart R Douglas Dmd Pllc 139 North Main St Cortland NY 13045 Ph: (607) 753-0602 |
| NPI Number | 1407941685 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407941685 | NPI | - | NPPES |
| 00562652 | Medicaid | NY | |
| 029842 | Other | DELTA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 029842 (New York) | Primary |
| 122300000X | Dentist | 052962 (New York) | Secondary |
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