Provider Demographics
NPI:1518723873
Name:STEWART, KRISTA LEIGH (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEIGH
Last Name:STEWART
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12153 POND PINE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4475
Mailing Address - Country:US
Mailing Address - Phone:240-481-0358
Mailing Address - Fax:
Practice Address - Street 1:18119 CASHELL RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2003
Practice Address - Country:US
Practice Address - Phone:301-820-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4640124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist