Provider Demographics
NPI:1659546661
Name:STUEDLI, EDWARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:STUEDLI
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 1:8441 DEHLINGER LN
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9708
Mailing Address - Country:US
Mailing Address - Phone:541-884-9621
Mailing Address - Fax:
Practice Address - Street 1:909 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2570
Practice Address - Country:US
Practice Address - Phone:541-663-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR51321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5132OtherSTATE OF OREGON DENTAL BOARD