Provider Demographics
NPI:1023319357
Name:STEWART, BETHANY (DDS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 ROYAL LN
Mailing Address - Street 2:SUITE# 634-214
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3856
Mailing Address - Country:US
Mailing Address - Phone:214-368-4100
Mailing Address - Fax:214-368-4102
Practice Address - Street 1:5959 ROYAL LN
Practice Address - Street 2:SUITE# 634-214
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3856
Practice Address - Country:US
Practice Address - Phone:214-368-4100
Practice Address - Fax:214-368-4102
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18553641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice