Individual
BRUCE RAY STUMBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
122 W WOODLAWN ROAD SUITE A 100, CHARLOTTE, NC 28217-2172
(704) 525-8528
(704) 525-9311
Mailing address
122 W WOODLAWN ROAD SUITE A 100, CHARLOTTE, NC 28217-2172
(704) 525-8528
(704) 525-9311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3723
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
98185
BC BS
NC
05
—
U48839
—
NC
Enumeration date
10/18/2006
Last updated
07/08/2007
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