Provider Demographics
NPI:1073698379
Name:STEWART, TODD CHRISTOPHER (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:CHRISTOPHER
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 HICKORY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-2302
Mailing Address - Country:US
Mailing Address - Phone:870-338-3961
Mailing Address - Fax:870-338-3950
Practice Address - Street 1:118 HICKORY HILLS DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-2302
Practice Address - Country:US
Practice Address - Phone:870-338-3961
Practice Address - Fax:870-338-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59965OtherBLUE CROSS BLUE SHIELD
807943OtherUNITED CONCORDIA