Provider Demographics
NPI:1912064411
Name:STEWART, ELIZABETH DRU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DRU
Last Name:STEWART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-9220
Mailing Address - Country:US
Mailing Address - Phone:765-584-0971
Mailing Address - Fax:765-584-4401
Practice Address - Street 1:871 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9220
Practice Address - Country:US
Practice Address - Phone:765-584-0971
Practice Address - Fax:765-584-4401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist