Provider Demographics
NPI:1568532828
Name:STEWART, BRYAN R (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:R
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 1:5975 FM 78
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244
Mailing Address - Country:US
Mailing Address - Phone:210-661-4211
Mailing Address - Fax:210-661-3308
Practice Address - Street 1:5975 FM 78
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244
Practice Address - Country:US
Practice Address - Phone:210-661-4211
Practice Address - Fax:210-661-3308
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice