Provider Demographics
NPI:1770815235
Name:STEWART, ELIZABETH CLARKE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CLARKE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:C
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:3001 W ILLINOIS AVE
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3180
Mailing Address - Country:US
Mailing Address - Phone:432-682-6842
Mailing Address - Fax:
Practice Address - Street 1:3001 W ILLINOIS AVE
Practice Address - Street 2:SUITE 6A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3180
Practice Address - Country:US
Practice Address - Phone:432-682-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10896124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist