Provider Demographics
NPI:1932501087
Name:CARINA G STEWART DDS INC
Entity Type:Organization
Organization Name:CARINA G STEWART DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-832-2087
Mailing Address - Street 1:17050 CHATSWORTH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7804
Mailing Address - Country:US
Mailing Address - Phone:818-832-2087
Mailing Address - Fax:818-832-1857
Practice Address - Street 1:17050 CHATSWORTH ST STE 109
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7804
Practice Address - Country:US
Practice Address - Phone:818-832-2087
Practice Address - Fax:818-832-1857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARINA G STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42614305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization