Provider Demographics
NPI:1306421011
Name:STEWART, ALEXANDER MAXWELL (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MAXWELL
Last Name:STEWART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 WOOD BRIAR CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6254
Mailing Address - Country:US
Mailing Address - Phone:502-645-8828
Mailing Address - Fax:
Practice Address - Street 1:4010 SANDY BROOK DR STE 204
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1518
Practice Address - Country:US
Practice Address - Phone:512-375-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001023-151223G0001X
390200000X
TX394741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program