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General NPI Number Information
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NPI Number | 1417389032
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Entity Type | Organization
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Legal Business Name | BIRTH STEWART ORAL SURGERY FT WORTH
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 3060 SYCAMORE SCHOOL RD
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City | FORT WORTH
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State | TX
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Zip | 76133-7771
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Country | US
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Telephone | 817-370-0268
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Fax | 817-263-9217
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Provider Business Mailing Address
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Address Line | PO BOX 330874
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City | FORT WORTH
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State | TX
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Zip | 76163-0874
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Country | US
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Telephone | 817-370-0268
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Fax | 817-263-9217
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. CHARLES STEWART
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Credential | DDS
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Telephone | 817-370-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19486
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11736
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License Number State | TX
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