Provider Demographics
NPI:1730261561
Name:STEWART, LYTHIA JEAN (DDS)
Entity type:Individual
Prefix:MRS
First Name:LYTHIA
Middle Name:JEAN
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 1:1336 N GALLOWAY AVENUE
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:972-329-5437
Mailing Address - Fax:972-329-5436
Practice Address - Street 1:1336 N GALLOWAY AVENUE
Practice Address - Street 2:SUITE # 110
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-329-5437
Practice Address - Fax:972-329-5436
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX17050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist