Provider Demographics
NPI:1033372776
Name:STETLER, KATHY J (DMD MSD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:STETLER
Suffix:
Gender:F
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 N WICKHAM RD
Mailing Address - Street 2:STE 4
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-255-9600
Mailing Address - Fax:
Practice Address - Street 1:4301 N WICKHAM RD
Practice Address - Street 2:STE 4
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2400
Practice Address - Country:US
Practice Address - Phone:321-255-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 156061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics