MEDICARE: DR. CHARLES DANIEL 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	11736	TX

General Provider Information

NPI Number	:	1508084674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DANIEL STEWART D.D.S.

Provider Business Mailing Address
First Line	:	7900 MORNING LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1926
Country	:	US
Telephone Number	:	817-346-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-7771
Country	:	US
Telephone Number	:	817-370-0268
Fax Number	:	817-263-9217

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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