Provider Demographics
NPI:1447355490
Name:STEGELMEIER, KREHL WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:KREHL
Middle Name:WILLIAM
Last Name:STEGELMEIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 W PABOR AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2153
Mailing Address - Country:US
Mailing Address - Phone:970-858-8484
Mailing Address - Fax:970-858-6436
Practice Address - Street 1:288 W PABOR AVE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2153
Practice Address - Country:US
Practice Address - Phone:970-858-8484
Practice Address - Fax:970-858-6436
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33173842Medicaid