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General NPI Number Information
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NPI Number | 1821150293
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Entity Type | Individual
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Provider Name | ROBERT C. STETZEL JR. BS, BA, MS, DDS
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 2900 KIRBY PARKWAY, STE 9
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City | MEMPHIS
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State | TN
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Zip | 38119-8207
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Country | US
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Telephone | 901-755-7392
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Fax | 901-755-6442
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Provider Business Mailing Address
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Address Line | 7205 GRAPETREE TRL
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City | CORDOVA
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State | TN
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Zip | 38018-7946
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Country | US
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Telephone | 901-266-0108
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Fax | 901-266-0108
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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 | 2750
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS4676
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License Number State | TN
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