Provider Demographics
NPI:1043797749
Name:BURT STEWART DMD PLLC
Entity Type:Organization
Organization Name:BURT STEWART DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SCHLEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-356-5277
Mailing Address - Street 1:6937 WEST 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-356-5277
Mailing Address - Fax:970-351-8788
Practice Address - Street 1:6937 WEST 10TH STREET
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-356-5277
Practice Address - Fax:970-351-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00202585261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental