Provider Demographics
NPI:1881738854
Name:STEWART, ROD C (DDS)
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:C
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 1:310 W MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-8825
Mailing Address - Country:US
Mailing Address - Phone:936-856-2500
Mailing Address - Fax:936-856-2548
Practice Address - Street 1:310 W MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8825
Practice Address - Country:US
Practice Address - Phone:936-856-2500
Practice Address - Fax:936-856-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741666701OtherFEDERAL TAX ID