Provider Demographics
NPI:1841387156
Name:STEWART, CAMERON SAYRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:SAYRE
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 1:860 S 2ND
Mailing Address - Street 2:SUITE D
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4072
Mailing Address - Country:US
Mailing Address - Phone:509-529-3470
Mailing Address - Fax:509-529-3474
Practice Address - Street 1:860 S 2ND
Practice Address - Street 2:SUITE D
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4072
Practice Address - Country:US
Practice Address - Phone:509-529-3470
Practice Address - Fax:509-529-3474
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006438122300000X
IDD2004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5014667Medicaid
WA50004OtherLABORS INDUSTRIES