Provider Demographics
NPI:1275844607
Name:STETTLER, CORBAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORBAN
Middle Name:R
Last Name:STETTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 E WOODMEN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8067
Mailing Address - Country:US
Mailing Address - Phone:719-424-4668
Mailing Address - Fax:719-424-4667
Practice Address - Street 1:5430 E WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8067
Practice Address - Country:US
Practice Address - Phone:719-424-4668
Practice Address - Fax:719-424-4667
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000102991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry