Individual
STEPHANIE NETTLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
946 E STATE ST, MASON CITY, IA 50401-4202
(641) 424-4521
(641) 424-8403
Mailing address
946 E STATE ST, MASON CITY, IA 50401-4202
(641) 424-4521
(641) 424-8403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7715
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1109967
—
IA
01
—
16804
BLUE CROSS BLUE SHIELD
IA
01
—
7715
DELTA DENTAL
IA
01
—
867568
UNITED CONCORDIA
—
Enumeration date
10/06/2006
Last updated
07/08/2007
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