Provider Demographics
NPI:1215072467
Name:STEWART, REBECCA L (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
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 1:1127 HIGHWAY 71 S
Mailing Address - Street 2:PO BOX 1343
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4033
Mailing Address - Country:US
Mailing Address - Phone:479-394-6445
Mailing Address - Fax:479-394-7588
Practice Address - Street 1:1127 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4033
Practice Address - Country:US
Practice Address - Phone:479-394-6445
Practice Address - Fax:479-394-7588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice