Provider Demographics
NPI:1063449528
Name:STEWART, MARK R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:STEWART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1316 W COLLIN RAYE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2135
Mailing Address - Country:US
Mailing Address - Phone:870-584-3221
Mailing Address - Fax:870-642-6846
Practice Address - Street 1:1316 W COLLIN RAYE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2135
Practice Address - Country:US
Practice Address - Phone:870-584-3221
Practice Address - Fax:870-642-6846
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice