Healthcare Provider Details

I. General information

NPI: 1578609566
Provider Name (Legal Business Name): CHRISTOPHER DALE STEWARD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BROADWAY
CAVE CITY KY
42127
US

IV. Provider business mailing address

P.O. BOX 336 212 BROADWAY
CAVE CITY KY
42127
US

V. Phone/Fax

Practice location:
  • Phone: 270-773-2250
  • Fax: 270-773-4720
Mailing address:
  • Phone: 270-773-2250
  • Fax: 270-773-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5322
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6036P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: