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General NPI Number Information
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NPI Number | 1104999218
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN DENTISTRY, LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 2289 LAKEWAY DR. SUITE 5
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-0858
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Country | US
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Telephone | 270-866-8891
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 858 KEY VILLAGE SHOPPING CENTER
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-0858
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Country | US
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Telephone | 270-866-8891
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KYLE PATRICK STEWART
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Credential | DMD
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Telephone | 270-866-8891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5243
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License Number State | KY
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