MEDICARE: DR. CARINA G STEWART DDS

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	42614	CA

General Provider Information

NPI Number	:	1942419080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARINA G STEWART DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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