Provider Demographics
NPI:1760504484
Name:STEBBINS, MANDREA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANDREA
Middle Name:LYNN
Last Name:STEBBINS
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:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-0517
Mailing Address - Country:US
Mailing Address - Phone:406-862-3503
Mailing Address - Fax:406-862-4889
Practice Address - Street 1:401 BAKER AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2499
Practice Address - Country:US
Practice Address - Phone:406-862-3503
Practice Address - Fax:406-862-4889
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD1142Medicaid
MT1760504484Medicaid