Provider Demographics
NPI:1730443664
Name:STEWART, THOMAS ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:STEWART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3629
Mailing Address - Country:US
Mailing Address - Phone:806-272-5004
Mailing Address - Fax:806-272-5908
Practice Address - Street 1:108 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3629
Practice Address - Country:US
Practice Address - Phone:806-272-5004
Practice Address - Fax:806-272-5908
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist