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NPI Code Detail

MEDICARE: DR. DEREK STUTZ DMD

MEDICARE: DR. DEREK STUTZ 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
1122300000XDentist7579NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17579OTHERNVDENTAL LICENSE NUMBER

General Provider Information

NPI Number : 1396401816
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEREK STUTZ DMD
Provider Business Mailing Address
First Line : 7410 DARBY AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-3235
Country : US
Telephone Number : 702-401-5404
Fax Number :
Provider Business Practice Location Address
First Line : 6870 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2106
Country : US
Telephone Number : 702-825-7342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2021
Last Update Date : 11/09/2021

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Directions to “ DR. DEREK STUTZ DMD” Practice Location

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