Provider Demographics
NPI:1578609566
Name:STEWARD, CHRISTOPHER DALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:STEWARD
Suffix:
Gender:M
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:P.O. BOX 336
Mailing Address - Street 2:212 BROADWAY
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127
Mailing Address - Country:US
Mailing Address - Phone:270-773-2250
Mailing Address - Fax:270-773-4720
Practice Address - Street 1:212 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127
Practice Address - Country:US
Practice Address - Phone:270-773-2250
Practice Address - Fax:270-773-4720
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5322122300000X
KY6036P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60053220Medicaid