Provider Demographics
NPI:1255328506
Name:DUCHON, STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:DUCHON
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 1:110 S TIPPECANOE DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1140
Mailing Address - Country:US
Mailing Address - Phone:937-667-2417
Mailing Address - Fax:240-220-7701
Practice Address - Street 1:110 S TIPPECANOE DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1140
Practice Address - Country:US
Practice Address - Phone:937-667-2417
Practice Address - Fax:240-220-7701
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics