Active NPI
Derek Stutz, DMD
- Dentist
- Las Vegas, NV
National Provider Identifier
1396401816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7579
- Practice address
- 6870 S Rainbow Blvd
Las Vegas, NV 89118-2106 - Phone
- (702) 825-7342
- NPI assigned
- Nov 9, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7579 | NV | Primary |
Addresses
Primary practice location
6870 S Rainbow Blvd
Las Vegas, NV 89118-2106
Mailing address
7410 Darby Ave
Las Vegas, NV 89117-3235
Phone (702) 401-5404
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7579 | Other | NV | DENTAL LICENSE NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | rsgcw@aol.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7579 | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636416000000",
"number": "1396401816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7410 DARBY AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891173235",
"telephone_number": "702-401-5404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6870 S RAINBOW BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891182106",
"telephone_number": "702-825-7342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUTZ",
"first_name": "DEREK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-11-09",
"last_updated": "2021-11-09",
"certification_date": "2021-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "7579",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE NUMBER",
"identifier": "7579",
"state": "NV"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "rsgcw@aol.com",
"affiliation": "N",
"endpointDescription": "email",
"address_1": "6870 S Rainbow Blvd",
"city": "Las Vegas",
"state": "NV",
"country_code": "US",
"postal_code": "891182106",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.