Provider Demographics
NPI:1184850315
Name:STUCKI, GRANT KIMBALL (DDS, MS)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:KIMBALL
Last Name:STUCKI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 BRIARGLEN LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6909
Mailing Address - Country:US
Mailing Address - Phone:520-255-3132
Mailing Address - Fax:
Practice Address - Street 1:4763 BRIARGLEN LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-6909
Practice Address - Country:US
Practice Address - Phone:520-255-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622111223S0112X
UT85041841223S0112X
AZD0087731223S0112X
CO2027241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery