Individual
DR. COLLIN MILES STUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
605 OLD BALLAS RD, SAINT LOUIS, MO 63141-7000
(314) 256-2135
Mailing address
605 OLD BALLAS RD STE 130, SAINT LOUIS, MO 63141-7070
(314) 256-2135
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2014015503
MO
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2014006169
MO
Other
Enumeration date
04/10/2010
Last updated
09/07/2014
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