Provider Demographics
NPI:1871765719
Name:STEWART, LISA J (DDS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:S
Other - Last Name:HULEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:423 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-2038
Mailing Address - Country:US
Mailing Address - Phone:765-675-8745
Mailing Address - Fax:
Practice Address - Street 1:423 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-2038
Practice Address - Country:US
Practice Address - Phone:765-675-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120096611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice