Provider Demographics
NPI:1699980466
Name:DRS. STEWART, BARR & THORNE,PLLC
Entity type:Organization
Organization Name:DRS. STEWART, BARR & THORNE,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-822-4447
Mailing Address - Street 1:HC 63 BOX 3560
Mailing Address - Street 2:SUNRISE PROFESSIONAL BLDG
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-9722
Mailing Address - Country:US
Mailing Address - Phone:304-822-4447
Mailing Address - Fax:304-822-7943
Practice Address - Street 1:1035 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2804
Practice Address - Country:US
Practice Address - Phone:304-788-6647
Practice Address - Fax:301-777-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136032000Medicaid