Provider Demographics
NPI:1366634438
Name:STUMP, CELIA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CELIA
Middle Name:J
Last Name:STUMP
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 1:2431 W MAIN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:334-793-5334
Mailing Address - Fax:334-793-3693
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-793-5334
Practice Address - Fax:334-793-3693
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL43331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice