MEDICARE: CARINA G STEWART DDS INC

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	305R00000X	Preferred Provider Organization	42614	CA

General Provider Information

NPI Number	:	1932501087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARINA G STEWART DDS INC

Provider Business Mailing Address
First Line	:	17050 CHATSWORTH ST STE 109
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-7804
Country	:	US
Telephone Number	:	818-832-2087
Fax Number	:	818-832-1857

Provider Business Practice Location Address
First Line	:	17050 CHATSWORTH ST STE 109
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-7804
Country	:	US
Telephone Number	:	818-832-2087
Fax Number	:	818-832-1857

Authorized Official
Title or Position	:	CEO
Name	:	CARINA STEWART
Credential	:
Telephone Number	:	818-832-2087

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	09/19/2014

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