Provider Demographics
NPI:1306146923
Name:STUKES, SUSAN DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DENISE
Last Name:STUKES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8127 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-3530
Mailing Address - Country:US
Mailing Address - Phone:267-331-9832
Mailing Address - Fax:
Practice Address - Street 1:8127 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150
Practice Address - Country:US
Practice Address - Phone:267-331-9832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist