Provider Demographics
NPI:1407882301
Name:STEWART, RICHARD WILLIAM (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAM
Last Name:STEWART
Suffix:
Gender:M
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:PO BOX 190
Mailing Address - Street 2:135 S. MAIN STREET
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-0190
Mailing Address - Country:US
Mailing Address - Phone:630-365-9438
Mailing Address - Fax:630-365-0424
Practice Address - Street 1:135 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-9108
Practice Address - Country:US
Practice Address - Phone:630-365-9438
Practice Address - Fax:630-365-0424
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice