MEDICARE: DAVID STUBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	58884	CA

General Provider Information

NPI Number	:	1588995377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID STUBBS

Provider Business Mailing Address
First Line	:	3333 BEACON ST # D
Second Line	:	48
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-3431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601E PAUL JONES ST
Second Line	:	BUILDING 42
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-2845
Country	:	US
Telephone Number	:	847-688-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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Directions to “ DAVID STUBBS ” Practice Location

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