Provider Demographics
NPI:1265574537
Name:SCOTT W STEWART DMD PLLC
Entity type:Organization
Organization Name:SCOTT W STEWART DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-692-1134
Mailing Address - Street 1:2021 NW MYHRE PL
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8562
Mailing Address - Country:US
Mailing Address - Phone:360-692-1134
Mailing Address - Fax:360-613-2787
Practice Address - Street 1:2021 NW MYHRE PL
Practice Address - Street 2:SUITE 107
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8562
Practice Address - Country:US
Practice Address - Phone:360-692-1134
Practice Address - Fax:360-613-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051396Medicaid