Provider Demographics
NPI:1467007740
Name:STUBBS, AUSTIN JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JOHN
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 1:351 W 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-7006
Mailing Address - Fax:
Practice Address - Street 1:36000 SHOEMAKER LANE
Practice Address - Street 2:SUITE 1051
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-5054
Practice Address - Country:US
Practice Address - Phone:913-461-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist