Provider Demographics
NPI:1053439422
Name:STEWART, CARL BRAXTON (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:BRAXTON
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 1:291 RENNER PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1342
Mailing Address - Country:US
Mailing Address - Phone:972-238-9691
Mailing Address - Fax:972-238-9778
Practice Address - Street 1:291 RENNER PKWY STE C
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1342
Practice Address - Country:US
Practice Address - Phone:972-238-9691
Practice Address - Fax:972-238-9778
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics