Provider Demographics
NPI:1427255496
Name:C. LEE STEWART D.M.D. ,PA
Entity type:Organization
Organization Name:C. LEE STEWART D.M.D. ,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-631-0606
Mailing Address - Street 1:895 BARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3143
Mailing Address - Country:US
Mailing Address - Phone:321-631-0606
Mailing Address - Fax:321-631-7041
Practice Address - Street 1:895 BARTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3143
Practice Address - Country:US
Practice Address - Phone:321-631-0606
Practice Address - Fax:321-631-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN101711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty