Provider Demographics
NPI:1518043215
Name:STUCKEY, CLAY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:W
Last Name:STUCKEY
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 1:1326 L ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3211
Mailing Address - Country:US
Mailing Address - Phone:812-279-3282
Mailing Address - Fax:
Practice Address - Street 1:1326 L ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3211
Practice Address - Country:US
Practice Address - Phone:812-279-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007276A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist