Individual
MR. CHARLES R STUCKEN SR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8847 IMPERIAL HWY, SUITE C-2, DOWNEY, CA 90242
(562) 861-4011
(562) 861-2601
Mailing address
8847 IMPERIAL HWY, SUITE C-2, DOWNEY, CA 90242
(562) 861-4011
(562) 861-2601
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
28992
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B2899201
MEDI CAL
CA
Enumeration date
01/06/2006
Last updated
07/08/2007
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