Provider Demographics
NPI:1487981031
Name:TODD L STEWART DDS AND ASSOCIATES PA
Entity type:Organization
Organization Name:TODD L STEWART DDS AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-235-6075
Mailing Address - Street 1:9739 NORTHLAKE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-6400
Mailing Address - Country:US
Mailing Address - Phone:704-235-6075
Mailing Address - Fax:704-235-6076
Practice Address - Street 1:9739 NORTHLAKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-6400
Practice Address - Country:US
Practice Address - Phone:704-235-6075
Practice Address - Fax:704-235-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75281223G0001X
NC83361223G0001X
NC86811223G0001X
NC81241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910080Medicaid
NC5909475Medicaid
NC5904095Medicaid
NC5906000Medicaid