Provider Demographics
NPI:1679600357
Name:STUART, THOMAS CLAY (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CLAY
Last Name:STUART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:T
Other - Middle Name:CLAY
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, PSC
Mailing Address - Street 1:151 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1600
Mailing Address - Country:US
Mailing Address - Phone:859-236-8229
Mailing Address - Fax:
Practice Address - Street 1:151 N 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1600
Practice Address - Country:US
Practice Address - Phone:859-236-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice