Provider Demographics
NPI:1841291572
Name:STUCK, PAUL EDWIN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWIN
Last Name:STUCK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1853
Mailing Address - Country:US
Mailing Address - Phone:724-775-7600
Mailing Address - Fax:
Practice Address - Street 1:1300 5TH ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1853
Practice Address - Country:US
Practice Address - Phone:724-775-7600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018167L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice