Provider Demographics
NPI:1326810276
Name:STEWART, NIKKI DANA (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:DANA
Last Name:STEWART
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18407 LAFAYETTE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4727
Mailing Address - Country:US
Mailing Address - Phone:952-649-9393
Mailing Address - Fax:
Practice Address - Street 1:1650 W 82ND ST STE 850
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1460
Practice Address - Country:US
Practice Address - Phone:952-432-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6135124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist