Provider Demographics
NPI:1043345531
Name:STEWART, BARR & THORNE, DDS INC
Entity Type:Organization
Organization Name:STEWART, BARR & THORNE, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-530-2775
Mailing Address - Street 1:HC 63 BOX 3560
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-9722
Mailing Address - Country:US
Mailing Address - Phone:304-530-2775
Mailing Address - Fax:304-530-3646
Practice Address - Street 1:HC 63 BOX 3560
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-9722
Practice Address - Country:US
Practice Address - Phone:304-530-2775
Practice Address - Fax:304-530-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136032000Medicaid