Provider Demographics
NPI:1588781124
Name:STUCKI, GRANT TURNER (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:TURNER
Last Name:STUCKI
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 1:20 W MAIN STREET CT
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1889
Mailing Address - Country:US
Mailing Address - Phone:801-756-3570
Mailing Address - Fax:801-756-7925
Practice Address - Street 1:20 W MAIN STREET CT
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1889
Practice Address - Country:US
Practice Address - Phone:801-756-3570
Practice Address - Fax:801-756-7925
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT272193-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice