NPIMap

Organization Active NPI

Stuart Dental LLC

Doing business as Blue Mountain Dental Care

  • Dentist
  • Walla Walla, WA
National Provider Identifier
1023379633
Registry record updated May 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9646 Issued in WA
Legal business name
STUART DENTAL LLC
Doing business as
Blue Mountain Dental Care
Practice address
1545 Business One Cir
Walla Walla, WA 99362-9526
Phone
(509) 525-4662
Fax
(509) 525-0513
NPI assigned
May 31, 2012
Last updated
May 31, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcy Bolster
Title
Office Coordinator
Phone
(509) 525-4662

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9646 WA Primary

Addresses

Primary practice location

1545 Business One Cir
Walla Walla, WA 99362-9526

Mailing address

1545 Business One Cir
Walla Walla, WA 99362-9526
Phone (509) 525-4662

Other names 1

  • Blue Mountain Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

1545 Business One Cir
Walla Walla, WA 99362
Phone (509) 525-4462

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1023379633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 BUSINESS ONE CIR",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993629526",
            "telephone_number": "509-525-4662",
            "fax_number": "509-525-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 BUSINESS ONE CIR",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993629526",
            "telephone_number": "509-525-4662",
            "fax_number": "509-525-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUART DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "BOLSTER",
        "authorized_official_first_name": "MARCY",
        "authorized_official_title_or_position": "OFFICE COORDINATOR",
        "authorized_official_telephone_number": "509-525-4662"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "9646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Mountain Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.