MEDICARE: DR. STEWART GLEN POWERS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13384	TX

General Provider Information

NPI Number	:	1154324606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEWART GLEN POWERS DDS

Provider Business Mailing Address
First Line	:	PO BOX 448
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-0448
Country	:	US
Telephone Number	:	972-617-3508
Fax Number	:	972-576-5202

Provider Business Practice Location Address
First Line	:	205 PIERCE RD
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-6415
Country	:	US
Telephone Number	:	972-617-3508
Fax Number	:	972-576-5202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	07/08/2007

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