Provider Demographics
NPI:1497315147
Name:KATHERINE F. STEWART D.D.S, L.L.C
Entity Type:Organization
Organization Name:KATHERINE F. STEWART D.D.S, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-229-7754
Mailing Address - Street 1:6508 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4424
Mailing Address - Country:US
Mailing Address - Phone:815-977-3080
Mailing Address - Fax:815-708-6086
Practice Address - Street 1:6508 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4424
Practice Address - Country:US
Practice Address - Phone:815-977-3080
Practice Address - Fax:815-708-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty