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General NPI Number Information
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NPI Number | 1396327623
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Entity Type | Organization
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Legal Business Name | CASSANDRA R STEWART DDS MPH PA
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 5937 HIGHWAY 42
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City | ELLENWOOD
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State | GA
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Zip | 30294-3800
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Country | US
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Telephone | 248-342-7057
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Fax | 678-567-7928
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Provider Business Mailing Address
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Address Line | 3048 LAWSON DR
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City | MARIETTA
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State | GA
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Zip | 30064-6418
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Country | US
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Telephone | 248-342-7057
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Fax | 678-567-7928
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Authorized Official
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Title or Position | CEO
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Name | DR. CASSANDRA R STEWART
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Credential | DDS
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Telephone | 734-330-1923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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