Provider Demographics
NPI:1780809616
Name:STEWART, THOMAS C JR (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:STEWART
Suffix:JR
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 1:212 OUTLET POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5667
Mailing Address - Country:US
Mailing Address - Phone:803-772-8190
Mailing Address - Fax:803-772-8191
Practice Address - Street 1:212 OUTLET POINTE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5667
Practice Address - Country:US
Practice Address - Phone:803-772-8190
Practice Address - Fax:803-772-8191
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice