Healthcare Provider Details

I. General information

NPI: 1124244686
Provider Name (Legal Business Name): RANDALL WAYNE STETTLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR BUILDING 1, SUITE 129
LA MESA CA
91942-3020
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR BUILDING 1, SUITE 129
LA MESA CA
91942-3020
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-4486
  • Fax: 619-463-6553
Mailing address:
  • Phone: 619-463-4486
  • Fax: 619-463-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: