Provider Demographics
NPI:1376790352
Name:STUBBLEFIELD, HEIDI GONZALEZ (DDS)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:GONZALEZ
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6341
Mailing Address - Country:US
Mailing Address - Phone:661-377-6453
Mailing Address - Fax:661-377-7000
Practice Address - Street 1:3450 STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6341
Practice Address - Country:US
Practice Address - Phone:661-377-6453
Practice Address - Fax:661-377-7000
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA572661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice