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General NPI Number Information
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NPI Number | 1285003210
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Entity Type | Individual
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Provider Name | BRYAN STEWART
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Gender | Male
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 1625 RIO BRAVO BLVD SW SUITE 33
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-6057
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Country | US
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Telephone | 505-431-6779
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Fax | 505-212-0789
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Provider Business Mailing Address
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Address Line | 1625 RIO BRAVO BLVD SW SUITE 33
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-6057
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Country | US
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Telephone | 505-431-6779
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Fax | 505-212-0789
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4334
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License Number State | NM
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