Provider Demographics
NPI:1821150293
Name:STETZEL, ROBERT C JR (BS, BA, MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:STETZEL
Suffix:JR
Gender:M
Credentials:BS, BA, MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 GRAPETREE TRL
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7946
Mailing Address - Country:US
Mailing Address - Phone:901-266-0108
Mailing Address - Fax:901-266-0108
Practice Address - Street 1:2900 KIRBY PARKWAY, STE 9
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8207
Practice Address - Country:US
Practice Address - Phone:901-755-7392
Practice Address - Fax:901-755-6442
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27501223G0001X
TNDS4676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441837Medicaid