Provider Demographics
NPI:1497761308
Name:STELTENPOHL, JAMES A (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:STELTENPOHL
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 1:4801 OUTER LOOP
Mailing Address - Street 2:C524
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3201
Mailing Address - Country:US
Mailing Address - Phone:502-966-8638
Mailing Address - Fax:502-964-7309
Practice Address - Street 1:4801 OUTER LOOP
Practice Address - Street 2:C524
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3201
Practice Address - Country:US
Practice Address - Phone:502-966-8638
Practice Address - Fax:502-964-7309
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice