# BIRTH STEWART ORAL SURGERY FT WORTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417389032
- **Authorized official:** DR. CHARLES STEWART DDS (ORTHODONTIST)
- **Authorized official phone:** (817) 370-0268

## Contact information

- **Practice address:** 3060 SYCAMORE SCHOOL RD, FORT WORTH, TX 76133-7771
- **Practice address phone:** (817) 370-0268
- **Practice address fax:** (817) 263-9217
- **Mailing address:** PO BOX 330874, FORT WORTH, TX 76163-0874
- **Mailing address phone:** (817) 370-0268
- **Mailing address fax:** (817) 263-9217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 11736 | TX | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 19486 | TX | Yes |

## Other

- **Enumeration date:** 08/06/2013
- **Last updated:** 11/08/2013