Provider Demographics
NPI:1437179355
Name:ROUFF, STUART A
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:ROUFF
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:A
Other - Last Name:ROUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:95 RIVERSIDE DRIVE-SUITE B
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2720
Mailing Address - Country:US
Mailing Address - Phone:607-729-3675
Mailing Address - Fax:607-729-1327
Practice Address - Street 1:95 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2720
Practice Address - Country:US
Practice Address - Phone:607-729-3675
Practice Address - Fax:607-729-1327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0277231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice