Healthcare Provider Details

I. General information

NPI: 1639157654
Provider Name (Legal Business Name): CRAIG SCOTT STEWART DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
U S A F ACADEMY CO
80840-2502
US

IV. Provider business mailing address

5648 PIONEER MESA DR
COLORADO SPRINGS CO
80918-8793
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5190
  • Fax:
Mailing address:
  • Phone: 719-650-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16540
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: