Provider Demographics
NPI:1720464043
Name:STEWART, KALI (DMD)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 MASSACHUSETTS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1401
Mailing Address - Country:US
Mailing Address - Phone:813-244-5894
Mailing Address - Fax:
Practice Address - Street 1:950 BROADWAY APT 1C
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-889-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
MADN18575701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental