Provider Demographics
NPI:1215213905
Name:DAVID M. S. STEWART DDS PC
Entity Type:Organization
Organization Name:DAVID M. S. STEWART DDS PC
Other - Org Name:LITTLE PEOPLE'S DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MS
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-446-8007
Mailing Address - Street 1:1268 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4652
Mailing Address - Country:US
Mailing Address - Phone:801-446-8007
Mailing Address - Fax:801-676-1030
Practice Address - Street 1:1268 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4652
Practice Address - Country:US
Practice Address - Phone:801-446-8007
Practice Address - Fax:801-676-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529537623024Medicaid