Provider Demographics
NPI:1487618799
Name:STEWART, JAMES D (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
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 1:1430 BOSQUE FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-9326
Mailing Address - Country:US
Mailing Address - Phone:505-385-5205
Mailing Address - Fax:
Practice Address - Street 1:3615 STATE HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:PERALTA
Practice Address - State:NM
Practice Address - Zip Code:87042-8882
Practice Address - Country:US
Practice Address - Phone:505-565-0609
Practice Address - Fax:505-565-0709
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice