Provider Demographics
NPI:1871821546
Name:STUBBS, YVONNE DEMERDASH (DDS)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:DEMERDASH
Last Name:STUBBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15430 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5157
Mailing Address - Country:US
Mailing Address - Phone:262-797-8303
Mailing Address - Fax:262-797-9846
Practice Address - Street 1:15430 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5157
Practice Address - Country:US
Practice Address - Phone:262-797-8303
Practice Address - Fax:262-797-9846
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5263-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice