Provider Demographics
NPI:1518342336
Name:STUBBE, JENNIFER MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:STUBBE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:FLINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:180 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245-7732
Mailing Address - Country:US
Mailing Address - Phone:712-957-2460
Mailing Address - Fax:712-957-1013
Practice Address - Street 1:180 1ST ST NE
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-7732
Practice Address - Country:US
Practice Address - Phone:712-957-2460
Practice Address - Fax:712-957-1013
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist