Provider Demographics
NPI:1366471617
Name:STUBBLEFIELD, MICHAEL SEAN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SEAN
Last Name:STUBBLEFIELD
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 1:635 N ERIE ST
Mailing Address - Street 2:BILLING OFFICE MNGR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:419-213-4049
Mailing Address - Fax:419-213-4017
Practice Address - Street 1:635 N ERIE ST
Practice Address - Street 2:BILLING OFFICE MNGR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604
Practice Address - Country:US
Practice Address - Phone:419-213-4049
Practice Address - Fax:419-213-4017
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0216021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8822331Medicaid
OH10246OtherPARAMOUNT HEALTH
OH01546670OtherUNITED CONCORDIA DENTAL
OH600972OtherBUCKEYE COMMUNITY HEALTH
OH9175730OtherDORAL DENTAL