Healthcare Provider Details

I. General information

NPI: 1568621068
Provider Name (Legal Business Name): ROXANNA MERINDA STEWART DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 COY SMITH HWY E
MOUNT VERNON AL
36560-3322
US

IV. Provider business mailing address

PO BOX 1090 SEARCY HOSPITAL
MOUNT VERNON AL
36560-1090
US

V. Phone/Fax

Practice location:
  • Phone: 251-662-6822
  • Fax:
Mailing address:
  • Phone: 251-662-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3666
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: