Provider Demographics
NPI:1790018232
Name:STEWART, JON-CHRISTIAN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON-CHRISTIAN
Middle Name:N
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 1:2129 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5327
Mailing Address - Country:US
Mailing Address - Phone:318-797-1873
Mailing Address - Fax:318-797-8892
Practice Address - Street 1:2129 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5327
Practice Address - Country:US
Practice Address - Phone:318-797-1873
Practice Address - Fax:318-797-8892
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice