Provider Demographics
NPI:1609056563
Name:STEWART, COURTNEY (RDH)
Entity Type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALBANY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120
Mailing Address - Country:US
Mailing Address - Phone:860-249-9625
Mailing Address - Fax:860-808-1580
Practice Address - Street 1:500 ALBANY AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120
Practice Address - Country:US
Practice Address - Phone:860-249-9625
Practice Address - Fax:860-808-1580
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007019124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist