Provider Demographics
NPI:1508870684
Name:STEWART, EDGAR ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ALAN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 SAINT NICHOLAS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7747
Mailing Address - Country:US
Mailing Address - Phone:907-490-4629
Mailing Address - Fax:907-490-4649
Practice Address - Street 1:2595 SAINT NICHOLAS DR
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7747
Practice Address - Country:US
Practice Address - Phone:907-490-4629
Practice Address - Fax:907-490-4649
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice