Provider Demographics
NPI:1730630815
Name:HENRY I. STEWART IV, DDS
Entity type:Organization
Organization Name:HENRY I. STEWART IV, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-740-9127
Mailing Address - Street 1:12091 GAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3401
Mailing Address - Country:US
Mailing Address - Phone:804-740-9127
Mailing Address - Fax:804-740-9127
Practice Address - Street 1:12091 GAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3401
Practice Address - Country:US
Practice Address - Phone:804-740-9127
Practice Address - Fax:804-740-9127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty