Active NPI
R. Clarke Stewart, D.M.D.
- Periodontics
- Jackson, MS
National Provider Identifier
1417166703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2364-87
- Practice address
- 406 Briarwood Dr Ste 101
Jackson, MS 39206-3059 - Phone
- (601) 956-1230
- Fax
- (601) 956-0201
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 2364-87 | MS | Primary |
Addresses
Primary practice location
406 Briarwood Dr Ste 101
Jackson, MS 39206-3059
Mailing address
406 Briarwood Dr Ste 101
Jackson, MS 39206-3059
Phone (601) 956-1230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2364-87 | MS | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periodontal Associates of Jackson, P.a. | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Periodontics
- Jackson, MS
- NPI 1790069854
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417166703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 BRIARWOOD DR STE 101",
"city": "JACKSON",
"state": "MS",
"postal_code": "392063059",
"telephone_number": "601-956-1230",
"fax_number": "601-956-0201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 BRIARWOOD DR STE 101",
"city": "JACKSON",
"state": "MS",
"postal_code": "392063059",
"telephone_number": "601-956-1230",
"fax_number": "601-956-0201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "R.",
"middle_name": "CLARKE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MS",
"license": "2364-87",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.