Organization
STUCKEY & MUDD DDS
Active
Other names
SouthPark Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS STUCKEY DDS (GENERAL PARTNER)
(704) 364-9686
Entity
Organization
Contact information
Practice address
6865 FAIRVIEW RD, SUITE A, CHARLOTTE, NC 28210-2700
(704) 364-9686
Mailing address
6865 FAIRVIEW RD, SUITE A, CHARLOTTE, NC 28210-2700
(704) 364-9686
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
NC 7310
NC
261QD0000X
Dental Clinic/Center
Primary
NC5980
NC
Other
Enumeration date
03/21/2008
Last updated
03/21/2008
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