Provider Demographics
NPI:1700950722
Name:STUFFLEBEAM, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:STUFFLEBEAM
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 1:207 E CHURCH ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2972
Mailing Address - Country:US
Mailing Address - Phone:641-752-9550
Mailing Address - Fax:641-752-9517
Practice Address - Street 1:207 E CHURCH ST
Practice Address - Street 2:SUITE #3
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2972
Practice Address - Country:US
Practice Address - Phone:641-752-9550
Practice Address - Fax:641-752-9517
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0264416Medicaid
IA0264416Medicaid