MEDICARE: STEWART FAMILY DENTISTRY LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588353643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEWART FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	449 OLD IRON WORKS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-4454
Country	:	US
Telephone Number	:	864-583-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1327 DRAYTON RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-5106
Country	:	US
Telephone Number	:	864-680-1016
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. WILLIAM BOZEMAN STEWART
Credential	:	DMD
Telephone Number	:	864-583-0793

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	06/03/2026

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