Provider Demographics
NPI:1083884233
Name:STUBBLEFIELD, TERRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:STUBBLEFIELD
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 1:8935 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2201
Mailing Address - Country:US
Mailing Address - Phone:662-895-5012
Mailing Address - Fax:662-895-4616
Practice Address - Street 1:8935 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2201
Practice Address - Country:US
Practice Address - Phone:662-895-5012
Practice Address - Fax:662-895-4616
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS279894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist