Provider Demographics
NPI:1003831199
Name:STUMP, JEFFREY ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:STUMP
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-0645
Mailing Address - Country:US
Mailing Address - Phone:970-668-3118
Mailing Address - Fax:970-668-3166
Practice Address - Street 1:101 WEST MAIN ST
Practice Address - Street 2:STE. 105
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-0645
Practice Address - Country:US
Practice Address - Phone:970-668-3118
Practice Address - Fax:970-668-3166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics