Provider Demographics
NPI:1962554899
Name:THOMAS K. & CHERYL A. STEWART, DDS, LTD.
Entity type:Organization
Organization Name:THOMAS K. & CHERYL A. STEWART, DDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-244-1925
Mailing Address - Street 1:7023 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5101 WASHINGTON ST
Practice Address - Street 2:SUITE 2K
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-244-1925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty