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General NPI Number Information
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NPI Number | 1992976559
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Entity Type | Organization
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Legal Business Name | STUCKEY & MUDD DDS
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 6865 FAIRVIEW RD SUITE A
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City | CHARLOTTE
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State | NC
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Zip | 28210-2700
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Country | US
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Telephone | 704-364-9686
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Fax |
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Provider Business Mailing Address
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Address Line | 6865 FAIRVIEW RD SUITE A
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City | CHARLOTTE
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State | NC
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Zip | 28210-2700
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Country | US
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Telephone | 704-364-9686
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. DOUGLAS STUCKEY
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Credential | DDS
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Telephone | 704-364-9686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | NC 7310
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | NC5980
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License Number State | NC
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