Healthcare Provider Details

I. General information

NPI: 1558554600
Provider Name (Legal Business Name): PAUL HOWARD STUETZER DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W 13TH ST
SILVER CITY NM
88061
US

IV. Provider business mailing address

1301 NO VIRGINIA ST
SILVER CITY NM
88061-4617
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-8858
  • Fax: 505-388-8858
Mailing address:
  • Phone: 505-388-8858
  • Fax: 505-388-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number337RX1
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: