Provider Demographics
NPI:1437422433
Name:STUBBS, NICHOLAS VERN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:VERN
Last Name:STUBBS
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 1:5495 CARLSON DR STE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-2442
Mailing Address - Country:US
Mailing Address - Phone:916-739-1242
Mailing Address - Fax:916-739-0206
Practice Address - Street 1:5495 CARLSON DR.
Practice Address - Street 2:SUITE E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2442
Practice Address - Country:US
Practice Address - Phone:916-739-1242
Practice Address - Fax:916-739-0206
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist