Provider Demographics
NPI:1043246135
Name:STUCKEY, JAMES BALLENTINE SR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BALLENTINE
Last Name:STUCKEY
Suffix:SR
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 1:512 GLEN LAUREL DR
Mailing Address - Street 2:P.O.BOX 1445
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-2011
Mailing Address - Country:US
Mailing Address - Phone:864-859-8503
Mailing Address - Fax:
Practice Address - Street 1:512 GLEN LAUREL DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2011
Practice Address - Country:US
Practice Address - Phone:864-859-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice