Provider Demographics
NPI:1043803612
Name:STEWART, JOSHUA AARON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:AARON
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 1:234 DIXON CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4302
Mailing Address - Country:US
Mailing Address - Phone:336-312-5674
Mailing Address - Fax:
Practice Address - Street 1:THE DENTAL COLLEGE OF GEORGIA
Practice Address - Street 2:1120 15TH STREET, GC 5110
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-2251
Practice Address - Fax:706-723-0234
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122889390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty