Individual provider Active NPI

Kraig Stetzer, D.M.D

  • General Practice Dentistry
  • Salisbury, MD
National Provider Identifier
1598845026
Registry record updated Mar 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13031 Issued in MD
Practice address
1412 S Salisbury Blvd Ste 5
Salisbury, MD 21801-7148
Phone
(410) 546-5797
Fax
(410) 546-5798
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 13031 MD Primary

Addresses

Primary practice location

1412 S Salisbury Blvd Ste 5
Salisbury, MD 21801-7148

Mailing address

1412 S Salisbury Blvd Ste 5
Salisbury, MD 21801-7148
Phone (410) 546-5797

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150113001617 MD Order and Referring Only - DentistPractitioner - Dentist 0648594077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13031MDMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205452800000",
    "number": "1598845026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 S SALISBURY BLVD STE 5",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218017148",
            "telephone_number": "410-546-5797",
            "fax_number": "410-546-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 S SALISBURY BLVD STE 5",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218017148",
            "telephone_number": "410-546-5797",
            "fax_number": "410-546-5798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STETZER",
        "first_name": "KRAIG",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2008-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.