Provider Demographics
NPI:1245675339
Name:STEWART, CHAD LEE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:LEE
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 BARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3117
Mailing Address - Country:US
Mailing Address - Phone:321-631-0606
Mailing Address - Fax:
Practice Address - Street 1:895 BARTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3117
Practice Address - Country:US
Practice Address - Phone:321-631-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN101711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1427255496OtherTYPE 2 OR ORGINAZATIONAL NPI