Provider Demographics
NPI:1497719751
Name:STEWART, JOHN-MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN-MICHAEL
Middle Name:
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 1:8611 HILLCREST AVE
Mailing Address - Street 2:STE 235
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4203
Mailing Address - Country:US
Mailing Address - Phone:214-269-1244
Mailing Address - Fax:214-269-1245
Practice Address - Street 1:8611 HILLCREST AVE
Practice Address - Street 2:STE 235
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4203
Practice Address - Country:US
Practice Address - Phone:214-269-1244
Practice Address - Fax:214-269-1245
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010648Medicaid
MA0203751Medicaid
MA0203751Medicaid
V02647Medicare UPIN
MAX20137Medicare PIN