Provider Demographics
NPI:1134387681
Name:STUMP, GARY (DMD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:STUMP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MCCRARY DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3133
Mailing Address - Country:US
Mailing Address - Phone:423-586-4921
Mailing Address - Fax:423-307-8210
Practice Address - Street 1:307 MCCRARY DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3133
Practice Address - Country:US
Practice Address - Phone:423-586-4921
Practice Address - Fax:423-307-8210
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000074141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice