Provider Demographics
NPI:1144450289
Name:E. KEITH STUTZNEGGER, D.D.S., INC.
Entity type:Organization
Organization Name:E. KEITH STUTZNEGGER, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STUTZNEGGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-534-8330
Mailing Address - Street 1:455 ORO DAM BLVD E
Mailing Address - Street 2:SUITE E
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5733
Mailing Address - Country:US
Mailing Address - Phone:530-534-8330
Mailing Address - Fax:530-534-5767
Practice Address - Street 1:455 ORO DAM BLVD E
Practice Address - Street 2:SUITE E
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5733
Practice Address - Country:US
Practice Address - Phone:530-534-8330
Practice Address - Fax:530-534-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty