Healthcare Provider Details

I. General information

NPI: 1144530841
Provider Name (Legal Business Name): JULIAN SCOTT STEWART D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4458 JONESBORO RD
FOREST PARK GA
30297-4314
US

IV. Provider business mailing address

6108 SHARON WOODS BLVD
COLUMBUS OH
43229-2149
US

V. Phone/Fax

Practice location:
  • Phone: 301-674-8761
  • Fax:
Mailing address:
  • Phone: 301-674-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14712
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1000966
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN014757
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number055280
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.024074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: