Provider Demographics
NPI:1326054297
Name:STEWART, STACY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-2809
Mailing Address - Country:US
Mailing Address - Phone:609-586-6603
Mailing Address - Fax:609-586-1801
Practice Address - Street 1:2929 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-2809
Practice Address - Country:US
Practice Address - Phone:609-586-6603
Practice Address - Fax:609-586-1801
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ227481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice