Provider Demographics
NPI:1083829345
Name:STUBBS, LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:STUBBS
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 1:091 CASTLE ROCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077
Mailing Address - Country:US
Mailing Address - Phone:765-742-3100
Mailing Address - Fax:
Practice Address - Street 1:3711 ROME DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-742-3100
Practice Address - Fax:765-742-0152
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120102301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice