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General NPI Number Information
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NPI Number | 1154408045
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Entity Type | Individual
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Provider Name | RYAN MATTHEW STUNTZ DDS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 102 4TH AVE NE
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City | FARLEY
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State | IA
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Zip | 52046-0038
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Country | US
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Telephone | 563-744-3076
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Fax | 563-744-3150
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | FARLEY
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State | IA
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Zip | 52046-0038
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Country | US
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Telephone | 563-744-3076
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Fax | 563-744-3150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08322
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License Number State | IA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 1775730
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | UNITED CONCORDIA
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Identifier #2
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Identifier Code | 0468991
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Identifier #3
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Identifier Code | 39907
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | BLUE CROSS AND BLUE SHIEL
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Identifier #4
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Identifier Code | IA0101
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | JOHN DEERE
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Identifier #5
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Identifier Code | P90JT0YY
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | DELTA
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0468991
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Identifier #2
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Identifier Code | 1775730
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | UNITED CONCORDIA
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Identifier #3
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Identifier Code | 39907
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | BLUE CROSS AND BLUE SHIEL
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Identifier #4
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Identifier Code | IA0101
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | JOHN DEERE
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Identifier #5
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Identifier Code | P90JT0YY
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | DELTA
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