Provider Demographics
NPI:1396401816
Name:STUTZ, DEREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:STUTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 DARBY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3235
Mailing Address - Country:US
Mailing Address - Phone:702-401-5404
Mailing Address - Fax:
Practice Address - Street 1:6870 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2106
Practice Address - Country:US
Practice Address - Phone:702-825-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7579OtherDENTAL LICENSE NUMBER