Provider Demographics
NPI:1033268255
Name:STOUDENMIRE, JEFFREY RALPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RALPH
Last Name:STOUDENMIRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ALABAMA AVE W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3105
Mailing Address - Country:US
Mailing Address - Phone:334-636-2774
Mailing Address - Fax:334-636-2799
Practice Address - Street 1:325 ALABAMA AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3105
Practice Address - Country:US
Practice Address - Phone:334-636-2774
Practice Address - Fax:334-636-2799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice