MEDICARE: DR. KRAIG STETZER D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13031	MD

General Provider Information

NPI Number	:	1598845026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRAIG STETZER D.M.D

Provider Business Mailing Address
First Line	:	1412 S SALISBURY BLVD STE 5
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-7148
Country	:	US
Telephone Number	:	410-546-5797
Fax Number	:	410-546-5798

Provider Business Practice Location Address
First Line	:	1412 S SALISBURY BLVD STE 5
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-7148
Country	:	US
Telephone Number	:	410-546-5797
Fax Number	:	410-546-5798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/14/2008

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