Provider Demographics
NPI:1982706610
Name:STEWART, CATHLEEN HELEN TAPP (DMD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:HELEN TAPP
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 1:18601 VALLEY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316
Mailing Address - Country:US
Mailing Address - Phone:909-877-1818
Mailing Address - Fax:909-746-0400
Practice Address - Street 1:18601 VALLEY BOULEVARD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316
Practice Address - Country:US
Practice Address - Phone:909-746-0840
Practice Address - Fax:909-877-5468
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9805401OtherDELTA DENTAL