Provider Demographics
NPI:1508943986
Name:STUNTZ, WENDELL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:R
Last Name:STUNTZ
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 1:450 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4933
Mailing Address - Country:US
Mailing Address - Phone:712-322-7410
Mailing Address - Fax:
Practice Address - Street 1:40 NORTHCREST DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1622
Practice Address - Country:US
Practice Address - Phone:712-323-7589
Practice Address - Fax:712-323-8255
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0035436Medicaid