Provider Demographics
NPI:1891752762
Name:STEWART, CHARLES DONOVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DONOVAN
Last Name:STEWART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28925 BURLESON ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1714
Mailing Address - Country:US
Mailing Address - Phone:818-706-8821
Mailing Address - Fax:818-706-8889
Practice Address - Street 1:28925 BURLESON ST
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1714
Practice Address - Country:US
Practice Address - Phone:818-706-8821
Practice Address - Fax:818-706-8889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice