Provider Demographics
NPI:1790986156
Name:STEWART, TOM R (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:R
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4218
Mailing Address - Country:US
Mailing Address - Phone:405-624-1005
Mailing Address - Fax:405-743-8117
Practice Address - Street 1:607 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4218
Practice Address - Country:US
Practice Address - Phone:405-624-1005
Practice Address - Fax:405-743-8117
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics