Provider Demographics
NPI:1174848048
Name:GEGENHEIMER, STEWART M (DDS)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:M
Last Name:GEGENHEIMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DR. STEWART
Other - Middle Name:M
Other - Last Name:GEGENHEIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:23138 WITTIE LN
Mailing Address - Street 2:
Mailing Address - City:ROBERT
Mailing Address - State:LA
Mailing Address - Zip Code:70455-1824
Mailing Address - Country:US
Mailing Address - Phone:504-616-6213
Mailing Address - Fax:
Practice Address - Street 1:23138 WITTIE LN
Practice Address - Street 2:
Practice Address - City:ROBERT
Practice Address - State:LA
Practice Address - Zip Code:70455-1824
Practice Address - Country:US
Practice Address - Phone:504-616-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist