Provider Demographics
NPI:1144202722
Name:STEWART, NANCY M (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 N DECATUR RD
Mailing Address - Street 2:STE 111
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5917
Mailing Address - Country:US
Mailing Address - Phone:404-299-0123
Mailing Address - Fax:
Practice Address - Street 1:2754 N DECATUR RD
Practice Address - Street 2:STE 111
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5917
Practice Address - Country:US
Practice Address - Phone:404-299-0123
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0105201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice