Provider Demographics
NPI:1588353643
Name:STEWART FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:STEWART FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BOZEMAN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-680-1016
Mailing Address - Street 1:449 OLD IRON WORKS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4454
Mailing Address - Country:US
Mailing Address - Phone:864-680-1016
Mailing Address - Fax:
Practice Address - Street 1:1327 DRAYTON RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-5106
Practice Address - Country:US
Practice Address - Phone:864-680-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental