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Individual

DR. ROGER PATRICK STEWART

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D

Contact information

Practice address
2920 MARIETTA HWY, SUITE 146, CANTON, GA 30114-8212
(770) 704-6987
Mailing address
2920 MARIETTA HWY, SUITE 146, CANTON, GA 30114-8212
(770) 704-6987

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8625
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100599
AVESIS
GA
01
9182355
DORAL
GA
Enumeration date
12/13/2006
Last updated
07/08/2007
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