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General NPI Number Information
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NPI Number | 1649360082
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Entity Type | Organization
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Legal Business Name | CAROL A STUCKEY DDS
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 701 METAIRIE RD SUITE 1A 204
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City | METAIRIE
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State | LA
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Zip | 70005
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Country | US
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Telephone | 504-835-1349
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Fax | 504-832-3180
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Provider Business Mailing Address
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Address Line | 701 METAIRIE RD SUITE 1A 204
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City | METAIRIE
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State | LA
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Zip | 70005
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Country | US
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Telephone | 504-835-1349
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Fax | 504-832-3180
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Authorized Official
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Title or Position | OWNER ORTHODONTIST
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Name | MS. CAROL A STUCKEY
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Credential | DDS
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Telephone | 504-835-1349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3781
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License Number State | LA
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