Provider Demographics
NPI:1457852907
Name:STUBBS, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3515 COOLIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8014
Mailing Address - Country:US
Mailing Address - Phone:517-332-2422
Mailing Address - Fax:
Practice Address - Street 1:3515 COOLIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8014
Practice Address - Country:US
Practice Address - Phone:517-332-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist