Provider Demographics
NPI:1982846689
Name:ROBERT B. STEWART, DDS, MS, PC
Entity Type:Organization
Organization Name:ROBERT B. STEWART, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:313-882-8711
Mailing Address - Street 1:19635 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2535
Mailing Address - Country:US
Mailing Address - Phone:313-882-8711
Mailing Address - Fax:
Practice Address - Street 1:19635 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2535
Practice Address - Country:US
Practice Address - Phone:313-882-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010147511223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION19830OtherMEDICARE PROVIDER NUMBER
MI1285770057OtherPERSONAL NPI