Provider Demographics
NPI:1922178482
Name:RL STEWART DDS PC
Entity Type:Organization
Organization Name:RL STEWART DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-322-8040
Mailing Address - Street 1:2998 PANOLA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2312
Mailing Address - Country:US
Mailing Address - Phone:770-322-8040
Mailing Address - Fax:770-322-3024
Practice Address - Street 1:2998 PANOLA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2312
Practice Address - Country:US
Practice Address - Phone:770-322-8040
Practice Address - Fax:770-322-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty