Provider Demographics
NPI:1790102127
Name:RANDALL W. STETTLER, DDS, INC
Entity Type:Organization
Organization Name:RANDALL W. STETTLER, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:STETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-463-4486
Mailing Address - Street 1:5565 GROSSMONT CENTER DR
Mailing Address - Street 2:BUILDING 1, SUITE 129
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3020
Mailing Address - Country:US
Mailing Address - Phone:619-463-4486
Mailing Address - Fax:619-463-6553
Practice Address - Street 1:5565 GROSSMONT CENTER DR
Practice Address - Street 2:BUILDING 1, SUITE 129
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3020
Practice Address - Country:US
Practice Address - Phone:619-463-4486
Practice Address - Fax:619-463-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty