Provider Demographics
NPI:1205857794
Name:MCCUIN, STEPHEN DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DONALD
Last Name:MCCUIN
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:PO BOX 8308
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0308
Mailing Address - Country:US
Mailing Address - Phone:540-639-2921
Mailing Address - Fax:540-639-5576
Practice Address - Street 1:116 3RD AVE
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-4769
Practice Address - Country:US
Practice Address - Phone:540-639-2921
Practice Address - Fax:540-639-5576
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice