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General NPI Number Information
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NPI Number | 1659546661
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Entity Type | Individual
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Provider Name | EDWARD R STUEDLI DDS
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Gender | Male
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 909 ADAMS AVE
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City | LA GRANDE
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State | OR
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Zip | 97850-2570
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Country | US
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Telephone | 541-663-2728
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Fax |
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Provider Business Mailing Address
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Address Line | 8441 DEHLINGER LN
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-9708
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Country | US
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Telephone | 541-884-9621
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Fax |
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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 | 5132
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License Number State | OR
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