Provider Demographics
NPI:1114021508
Name:STUCKY, JAY R (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:R
Last Name:STUCKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 SIERRA PKWY
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2972
Mailing Address - Country:US
Mailing Address - Phone:620-663-9119
Mailing Address - Fax:620-663-2225
Practice Address - Street 1:3005 SIERRA PKWY
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2972
Practice Address - Country:US
Practice Address - Phone:620-663-9119
Practice Address - Fax:620-663-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17393OtherBCBS PVDR NUMBER