Provider Demographics
NPI:1841404464
Name:STELZNER, RANDAL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:G
Last Name:STELZNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RANDAL
Other - Middle Name:G
Other - Last Name:STELZNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10425 W NORTH AVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2416
Mailing Address - Country:US
Mailing Address - Phone:414-476-9910
Mailing Address - Fax:
Practice Address - Street 1:10425 W NORTH AVE
Practice Address - Street 2:SUITE #335
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2416
Practice Address - Country:US
Practice Address - Phone:414-476-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33470100Medicaid