Individual
DR. VICTOR WARD STUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
912 MEDALLION DR., GREENWOOD, MS 38930
(662) 453-5143
(662) 453-5143
Mailing address
912 MEDALLION DR., GREENWOOD, MS 38930
(662) 453-5143
(662) 453-5143
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3620-11
MS
1223G0001X
General Practice Dentistry
DN013045
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05481207
—
MS
Enumeration date
11/14/2007
Last updated
03/17/2014
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