MEDICARE: DR. LEAH STETZEL

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	RES.004246	OH
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30.027896	OH
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D011588	AZ
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12013400A	IN

General Provider Information

NPI Number	:	1962019984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH STETZEL

Provider Business Mailing Address
First Line	:	223 E TILLMAN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1079
Country	:	US
Telephone Number	:	260-447-2568
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E TILLMAN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1079
Country	:	US
Telephone Number	:	260-447-2568
Fax Number	:

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

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	07/15/2025

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Directions to “ DR. LEAH STETZEL ” Practice Location

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