# GRANT KIMBALL STUCKI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1184850315
- **Gender:** Man
- **Credential:** D.D.S., M.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 202724 | CO | Yes |
| 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