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General NPI Number Information
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NPI Number | 1821357740
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Entity Type | Individual
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Provider Name | AARON JAIRUS STUMP D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2012
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Last Update Date | 05/12/2012
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Provider Practice Location Address
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Address Line | 229 CONNOR DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-5604
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Country | US
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Telephone | 434-975-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 N PROSPECT AVE UNIT 1007
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City | MILWAUKEE
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State | WI
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Zip | 53202-1263
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Country | US
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Telephone | 317-260-9967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401413555
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License Number State | VA
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