Provider Demographics
NPI:1295049781
Name:STEWART, KEVIN DALE (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DALE
Last Name:STEWART
Suffix:
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 1:1102 ASPEN RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2947
Mailing Address - Country:US
Mailing Address - Phone:702-376-7374
Mailing Address - Fax:
Practice Address - Street 1:3600 E MCKINNEY ST STE 190
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-6543
Practice Address - Country:US
Practice Address - Phone:702-376-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice