=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295049781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN DALE STEWART D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2010
-----------------------------------------------------
Last Update Date | 07/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 E MCKINNEY ST STE 190
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76209-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-376-7374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1102 ASPEN RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76240-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-376-7374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 24935
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------