Provider Demographics
NPI:1013085372
Name:STUMP, NORMAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:L
Last Name:STUMP
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 1:2840 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-4724
Mailing Address - Country:US
Mailing Address - Phone:317-459-4204
Mailing Address - Fax:
Practice Address - Street 1:2840 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-4724
Practice Address - Country:US
Practice Address - Phone:317-459-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007740B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice