Provider Demographics
NPI:1780810465
Name:GRUBBS, STEPHEN LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:GRUBBS
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 1:930 BELHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1709
Mailing Address - Country:US
Mailing Address - Phone:601-278-9916
Mailing Address - Fax:
Practice Address - Street 1:930 BELHAVEN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1709
Practice Address - Country:US
Practice Address - Phone:601-278-9916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3499-09122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist