Provider Demographics
NPI:1477510600
Name:STULTZ, TODD W (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:W
Last Name:STULTZ
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32000 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1930
Mailing Address - Country:US
Mailing Address - Phone:216-217-1186
Mailing Address - Fax:216-636-5030
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:MAIL CODE JB-3
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-8221
Practice Address - Fax:216-636-5030
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0753672085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0563144Medicaid
OHH60105Medicare UPIN
OH0563144Medicaid