MEDICARE: DR. JOSHUA REID STUTZMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-023805	OH
2	1223G0001X	General Practice Dentistry	30-023805	OH

General Provider Information

NPI Number	:	1194069195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA REID STUTZMAN DMD

Provider Business Mailing Address
First Line	:	7710 SIGHTSEEING RD BLDG 2826
Second Line	:	USA DENTAL ACTIVITY
City	:	FORT BENNING
State	:	GA
Zip	:	31905-3764
Country	:	US
Telephone Number	:	706-544-4530
Fax Number	:	706-544-1933

Provider Business Practice Location Address
First Line	:	7710 SIGHTSEEING RD BLDG 2826
Second Line	:	USA DENTAL ACTIVITY
City	:	FORT BENNING
State	:	GA
Zip	:	31905-3764
Country	:	US
Telephone Number	:	706-544-4530
Fax Number	:	706-544-1933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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