Provider Demographics
NPI:1003953142
Name:STEWART, SCOTT W (DMD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 NW MYHRE PL
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8562
Mailing Address - Country:US
Mailing Address - Phone:360-692-1134
Mailing Address - Fax:360-613-2787
Practice Address - Street 1:2021 NW MYHRE PL
Practice Address - Street 2:SUITE 107
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8562
Practice Address - Country:US
Practice Address - Phone:360-692-1134
Practice Address - Fax:360-613-2787
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051396OtherDSHS