Provider Demographics
NPI:1154436715
Name:STELZER, GREGORY JOHN
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:STELZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:JOHN
Other - Last Name:STELZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:315 NICHOLS RD 198
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112
Mailing Address - Country:US
Mailing Address - Phone:816-561-3377
Mailing Address - Fax:
Practice Address - Street 1:315 NICHOLS RD 198
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112
Practice Address - Country:US
Practice Address - Phone:816-561-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist