Individual
DERIK E STUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3360 ROUTE 343, HUDSON RIVER HEALTHCARE, INC., AMENIA, NY 12501-5619
(845) 838-7038
(845) 373-7021
Mailing address
1037 MAIN ST, HUDSON RIVER HEALTHCARE, INC., PEEKSKILL, NY 10566-2913
(914) 734-8800
(845) 373-7021
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
054444
NY
122300000X
Dentist
TD-00-19
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03541646
—
NY
Enumeration date
04/29/2008
Last updated
02/19/2014
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