Provider Demographics
NPI:1891755864
Name:STEWART, LARRY ROLAND (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ROLAND
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 W 15TH ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7754
Mailing Address - Country:US
Mailing Address - Phone:972-596-9242
Mailing Address - Fax:972-612-0787
Practice Address - Street 1:3713 W 15TH ST
Practice Address - Street 2:SUITE #403
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7754
Practice Address - Country:US
Practice Address - Phone:972-596-9242
Practice Address - Fax:972-612-0787
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16122Medicare UPIN