Provider Demographics
NPI:1104948918
Name:STEWART, KATHERINE F (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:F
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 1:1075 FEATHERSTONE RD STE 30
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5906
Mailing Address - Country:US
Mailing Address - Phone:815-395-1711
Mailing Address - Fax:815-395-1705
Practice Address - Street 1:1075 FEATHERSTONE RD STE 30
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5906
Practice Address - Country:US
Practice Address - Phone:815-395-1711
Practice Address - Fax:815-395-1705
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBS2149727OtherDEA REGISTRATION NUMBER