Individual
TRENT LARRY STUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 505-8586
Mailing address
1874 N THISTLE DR, KUNA, ID 83634-3492
(208) 521-1089
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5503
ID
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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