Provider Demographics
NPI:1568485068
Name:STEWART, KEITH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
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 1:110 DEL RIO CT
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5125
Mailing Address - Country:US
Mailing Address - Phone:817-641-3331
Mailing Address - Fax:817-641-6191
Practice Address - Street 1:110 DEL RIO CT
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5125
Practice Address - Country:US
Practice Address - Phone:817-641-3331
Practice Address - Fax:817-641-6191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81537OtherUNITED CONCORDIA