MEDICARE: DR. BRADLEY WILLIAM STUTLER D.D.S.

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	332B00000X	Durable Medical Equipment & Medical Supplies	1841230638	IN
2	1223G0001X	General Practice Dentistry	12010504A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841230638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY WILLIAM STUTLER D.D.S.

Provider Business Mailing Address
First Line	:	1460 N GREEN ST
Second Line	:	SUITE 300
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-8117
Country	:	US
Telephone Number	:	317-852-6620
Fax Number	:	317-852-6680

Provider Business Practice Location Address
First Line	:	1460 N GREEN ST
Second Line	:	SUITE 300
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-8117
Country	:	US
Telephone Number	:	317-852-6620
Fax Number	:	317-852-6680

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	12/13/2018

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