Provider Demographics
NPI:1255483681
Name:STEWART, THOMAS KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEVIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5637
Mailing Address - Country:US
Mailing Address - Phone:847-855-9076
Mailing Address - Fax:
Practice Address - Street 1:5101 WASHINGTON ST
Practice Address - Street 2:SUITE 2K
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-244-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist