Provider Demographics
NPI:1265520738
Name:STEWART, LAWRENCE W (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:STEWART
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 1:15400 GRAND RIVER
Mailing Address - Street 2:STE. 4
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-4124
Mailing Address - Country:US
Mailing Address - Phone:313-837-3000
Mailing Address - Fax:313-838-4581
Practice Address - Street 1:15400 GRAND RIVER AVE
Practice Address - Street 2:STE. 4
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-4124
Practice Address - Country:US
Practice Address - Phone:313-837-3000
Practice Address - Fax:313-838-4581
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0177081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice