MEDICARE: DR. TRENA KAYE STEWART D.D.S.

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	122300000X	Dentist	5057	OK

General Provider Information

NPI Number	:	1164466975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRENA KAYE STEWART D.D.S.

Provider Business Mailing Address
First Line	:	6510 S WESTERN AVE STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1712
Country	:	US
Telephone Number	:	405-629-0020
Fax Number	:	405-629-0022

Provider Business Practice Location Address
First Line	:	6510 S WESTERN AVE STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1712
Country	:	US
Telephone Number	:	405-629-0020
Fax Number	:	405-629-0022

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	02/26/2021

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