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Individual
GRANT KIMBALL STUCKI
Active
Individual
GRANT KIMBALL STUCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
202724
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
62211
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
8504184
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D008773
AZ
Other
Enumeration date
06/02/2009
Last updated
05/03/2016
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