Provider Demographics
NPI:1538321005
Name:STUBBS, CASI B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CASI
Middle Name:B
Last Name:STUBBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 E HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9792
Mailing Address - Country:US
Mailing Address - Phone:850-678-8338
Mailing Address - Fax:850-897-9269
Practice Address - Street 1:4633 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9792
Practice Address - Country:US
Practice Address - Phone:850-678-8338
Practice Address - Fax:850-897-9269
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics