Active NPI
Kathy J Stetler, DMD MSD
- Periodontics
- Melbourne, FL
National Provider Identifier
1033372776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN 15606
- Practice address
- 4301 N Wickham Rd
Ste 4
Melbourne, FL 32935-2400 - Phone
- (321) 255-9600
- NPI assigned
- Jul 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN 15606 | FL | Primary |
Addresses
Primary practice location
4301 N Wickham Rd
Ste 4
Melbourne, FL 32935-2400
Mailing address
4301 N Wickham Rd
Ste 4
Melbourne, FL 32935
Phone (321) 255-9600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 25, 2015 through Mar 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 15606 | FL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214956800000",
"number": "1033372776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 N WICKHAM RD",
"address_2": "STE 4",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "32935",
"telephone_number": "321-255-9600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4301 N WICKHAM RD",
"address_2": "STE 4",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329352400",
"telephone_number": "321-255-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STETLER",
"first_name": "KATHY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DMD MSD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-02",
"last_updated": "2008-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "FL",
"license": "DN 15606",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.