Provider Demographics
NPI:1902967649
Name:MCCOMB & STEWART DENTISTRY, P.C.
Entity Type:Organization
Organization Name:MCCOMB & STEWART DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-643-6665
Mailing Address - Street 1:530 E MAIN ST
Mailing Address - Street 2:SUITE 720
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2418
Mailing Address - Country:US
Mailing Address - Phone:804-643-6665
Mailing Address - Fax:804-782-1146
Practice Address - Street 1:530 E MAIN ST
Practice Address - Street 2:SUITE 720
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2431
Practice Address - Country:US
Practice Address - Phone:804-643-6665
Practice Address - Fax:804-782-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106211223G0001X
VA04010051521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA574631OtherUNITED CONCORDIA
VA003204OtherANTHEM