Provider Demographics
NPI:1518641323
Name:STEWART, ASHTON ELIZABETH (DMD)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:ELIZABETH
Last Name:STEWART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 NE HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:LOWRY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64763-8111
Mailing Address - Country:US
Mailing Address - Phone:417-321-2437
Mailing Address - Fax:
Practice Address - Street 1:2105 W KEARNEY ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1666
Practice Address - Country:US
Practice Address - Phone:417-862-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023021221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist