Provider Demographics
NPI:1366640237
Name:NETZEL, STEPHEN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:NETZEL
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 1:7031 W PIUTE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5541
Mailing Address - Country:US
Mailing Address - Phone:623-561-6693
Mailing Address - Fax:623-561-6693
Practice Address - Street 1:6591 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3716
Practice Address - Country:US
Practice Address - Phone:602-920-6021
Practice Address - Fax:623-561-6693
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice