Provider Demographics
NPI:1821002312
Name:STUCKY, JOE CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:CHARLES
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 1:154 COLORADO AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3651
Mailing Address - Country:US
Mailing Address - Phone:970-249-1898
Mailing Address - Fax:970-240-3277
Practice Address - Street 1:154 COLORADO AVE
Practice Address - Street 2:STE 201
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3651
Practice Address - Country:US
Practice Address - Phone:970-249-1898
Practice Address - Fax:970-240-3277
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02072387OtherINDIVIDUAL
CO04019311Medicaid