MEDICARE: CORBAN STETTLER, DDS PC

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	20978	CO

General Provider Information

NPI Number	:	1700275062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORBAN STETTLER, DDS PC

Provider Business Mailing Address
First Line	:	5430 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8067
Country	:	US
Telephone Number	:	719-424-4668
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8067
Country	:	US
Telephone Number	:	719-424-4668
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	CORBAN STETTLER
Credential	:
Telephone Number	:	719-424-4668

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/09/2015

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