Provider Demographics
NPI:1831305903
Name:STETLER, CHARLES DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:STETLER
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 1:611 W BROWN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5387
Mailing Address - Country:US
Mailing Address - Phone:972-442-2515
Mailing Address - Fax:
Practice Address - Street 1:611 W BROWN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5387
Practice Address - Country:US
Practice Address - Phone:972-442-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist