Healthcare Provider Details

I. General information

NPI: 1265460497
Provider Name (Legal Business Name): STEWART WHITNEY PHARR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 DAVIS LANE SUITE 101
AUSTIN TX
78749
US

IV. Provider business mailing address

5301 DAVIS LANE SUITE 101
AUSTIN TX
78749
US

V. Phone/Fax

Practice location:
  • Phone: 512-960-4225
  • Fax: 512-960-4800
Mailing address:
  • Phone: 512-960-4225
  • Fax: 512-960-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number04014111498
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number28864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: