Provider Demographics
NPI:1720137011
Name:STUBBLEFIELD, CARL ELDEN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:ELDEN
Last Name:STUBBLEFIELD
Suffix:JR
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 1:8033 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2914
Mailing Address - Country:US
Mailing Address - Phone:913-215-9664
Mailing Address - Fax:913-215-9664
Practice Address - Street 1:8033 W 159TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2914
Practice Address - Country:US
Practice Address - Phone:913-215-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3838122300000X
IDD-38381223G0001X
KS62091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDBC6K869OtherBCBS