Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE00010586 | WA |
NPI | 1003953142 |
---|---|
Provider Name | Mr. Scott W Stewart |
First Address | Silverdale, WA 98383-8562 |
Second Address | Silverdale, WA 98383-8562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5051396 | DSHS (01) | WA |