Healthcare Provider Details

I. General information

NPI: 1932756608
Provider Name (Legal Business Name): SAVANAH L STEWART DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BROWNS LN
JONESBORO AR
72401-7227
US

IV. Provider business mailing address

608 BARBARA JEAN CT
WEBSTER GROVES MO
63119-2010
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-5445
  • Fax:
Mailing address:
  • Phone: 870-897-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4239
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: