MEDICARE: DR. NICHOLAS VERN STUBBS DDS

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	22420	CA

General Provider Information

NPI Number	:	1437422433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS VERN STUBBS DDS

Provider Business Mailing Address
First Line	:	5495 CARLSON DR STE E
Second Line	:	SUITE E
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2442
Country	:	US
Telephone Number	:	916-739-1242
Fax Number	:	916-739-0206

Provider Business Practice Location Address
First Line	:	5495 CARLSON DR.
Second Line	:	SUITE E
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2442
Country	:	US
Telephone Number	:	916-739-1242
Fax Number	:	916-739-0206

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

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	08/15/2013

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