Provider Demographics
NPI:1942440656
Name:STEWART, WILBURN CARSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILBURN
Middle Name:CARSON
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 TANGERINE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4835
Mailing Address - Country:US
Mailing Address - Phone:410-845-1016
Mailing Address - Fax:
Practice Address - Street 1:2013 TANGERINE ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4835
Practice Address - Country:US
Practice Address - Phone:410-845-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist