Provider Demographics
NPI:1871798033
Name:STUBBLEFIELD, EARL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:
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 1:6218 CHARLESTON COURT DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8098
Mailing Address - Country:US
Mailing Address - Phone:662-801-8275
Mailing Address - Fax:
Practice Address - Street 1:508 AZALEA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-8100
Practice Address - Country:US
Practice Address - Phone:662-236-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3263-03122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist