MEDICARE: RICHARD WILLIAM STEWART DMD

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		IL

General Provider Information

NPI Number	:	1407882301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD WILLIAM STEWART DMD

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:	135 S. MAIN STREET
City	:	ELBURN
State	:	IL
Zip	:	60119-0190
Country	:	US
Telephone Number	:	630-365-9438
Fax Number	:	630-365-0424

Provider Business Practice Location Address
First Line	:	135 S MAIN ST
Second Line	:
City	:	ELBURN
State	:	IL
Zip	:	60119-9108
Country	:	US
Telephone Number	:	630-365-9438
Fax Number	:	630-365-0424

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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