Provider Demographics
NPI:1396327623
Name:CASSANDRA R STEWART DDS MPH PA
Entity type:Organization
Organization Name:CASSANDRA R STEWART DDS MPH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-330-1923
Mailing Address - Street 1:3048 LAWSON DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6418
Mailing Address - Country:US
Mailing Address - Phone:248-342-7057
Mailing Address - Fax:678-567-7928
Practice Address - Street 1:5937 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3800
Practice Address - Country:US
Practice Address - Phone:248-342-7057
Practice Address - Fax:678-567-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty