Provider Demographics
NPI:1669669149
Name:STEWART C HO DMD PC
Entity Type:Organization
Organization Name:STEWART C HO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PROFESSIONAL CORPORATI
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:CHI CHIU
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-385-1617
Mailing Address - Street 1:3929 OLD LEE HIGHWAY
Mailing Address - Street 2:SUITE 91D
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2421
Mailing Address - Country:US
Mailing Address - Phone:703-385-1617
Mailing Address - Fax:703-865-7711
Practice Address - Street 1:3929 OLD LEE HIGHWAY
Practice Address - Street 2:SUITE 91D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2421
Practice Address - Country:US
Practice Address - Phone:703-385-1617
Practice Address - Fax:703-865-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty