Provider Demographics
NPI:1598845026
Name:STETZER, KRAIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:
Last Name:STETZER
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 1:1412 S SALISBURY BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7148
Mailing Address - Country:US
Mailing Address - Phone:410-546-5797
Mailing Address - Fax:410-546-5798
Practice Address - Street 1:1412 S SALISBURY BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7148
Practice Address - Country:US
Practice Address - Phone:410-546-5797
Practice Address - Fax:410-546-5798
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice