Provider Demographics
NPI:1164899068
Name:STONEBURNER, JEANELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEANELLE
Middle Name:
Last Name:STONEBURNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 8TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1707
Mailing Address - Country:US
Mailing Address - Phone:218-263-8348
Mailing Address - Fax:
Practice Address - Street 1:2005 8TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1707
Practice Address - Country:US
Practice Address - Phone:218-263-8348
Practice Address - Fax:218-263-5898
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist