Provider Demographics
NPI:1891961405
Name:J. R. STEWART, JR., D.D.S., P.C.
Entity Type:Organization
Organization Name:J. R. STEWART, JR., D.D.S., P.C.
Other - Org Name:JAMES R. STEWART, JR., D.D.S., P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-425-4400
Mailing Address - Street 1:15873 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3896
Mailing Address - Country:US
Mailing Address - Phone:734-425-4400
Mailing Address - Fax:734-425-8067
Practice Address - Street 1:15873 MIDDLEBELT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3896
Practice Address - Country:US
Practice Address - Phone:734-425-4400
Practice Address - Fax:734-425-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-03
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6473030001Medicare NSC