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General NPI Number Information
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NPI Number | 1063148526
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Entity Type | Individual
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Provider Name | DIANE STEWART RDH
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Gender | Female
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 1911 KENNEDY DR APT 302
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City | MC LEAN
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State | VA
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Zip | 22102-4729
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Country | US
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Telephone | 912-271-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 8960 BROWN DR
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City | BETHESDA
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State | MD
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Zip | 20889-5629
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Country | US
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Telephone | 301-295-2005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH26145
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License Number State | FL
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