Provider Demographics
NPI:1255735882
Name:STEWARDSON, THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:STEWARDSON
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 1:12071 FM 3522
Mailing Address - Street 2:ROBERTSON DENTAL CLINIC
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-8749
Mailing Address - Country:US
Mailing Address - Phone:325-548-9035
Mailing Address - Fax:
Practice Address - Street 1:12071 FM 3522
Practice Address - Street 2:ROBERTSON DENTAL CLINIC
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-8749
Practice Address - Country:US
Practice Address - Phone:325-548-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist