Provider Demographics
NPI:1417986787
Name:STUTZNEGGER, REX KIB
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:KIB
Last Name:STUTZNEGGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 W 9000 S
Mailing Address - Street 2:# 103
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6596
Mailing Address - Country:US
Mailing Address - Phone:801-255-7243
Mailing Address - Fax:
Practice Address - Street 1:1847 W 9000 S
Practice Address - Street 2:# 103
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6596
Practice Address - Country:US
Practice Address - Phone:801-255-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133253-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist