Provider Demographics
NPI:1982031928
Name:JR STEWART D.D.S. ENTERPRISES LLC
Entity Type:Organization
Organization Name:JR STEWART D.D.S. ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-733-2929
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:108 SOUTH ILLINOIS STREET
Mailing Address - City:WANATAH
Mailing Address - State:IN
Mailing Address - Zip Code:46390-0359
Mailing Address - Country:US
Mailing Address - Phone:219-733-2929
Mailing Address - Fax:219-733-1329
Practice Address - Street 1:108 SOUTH ILLINOIS STREET
Practice Address - Street 2:
Practice Address - City:WANATAH
Practice Address - State:IN
Practice Address - Zip Code:46390-0359
Practice Address - Country:US
Practice Address - Phone:219-733-2929
Practice Address - Fax:219-733-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-05
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8658332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies