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General NPI Number Information
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NPI Number | 1366577504
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Entity Type | Individual
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Provider Name | BRADLEY M STEWART DMD
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 6855 CRUMPLER BLVD STE 100
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1938
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Country | US
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Telephone | 662-893-5800
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Fax | 662-890-5614
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Provider Business Mailing Address
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Address Line | 6855 CRUMPLER BLVD STE 100
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1938
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Country | US
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Telephone | 662-893-5800
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Fax | 662-890-5614
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3105-99
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License Number State | MS
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