MEDICARE: DR. THOMAS ELON TUCKER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	011667	MO

General Provider Information

NPI Number	:	1568401115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ELON TUCKER DDS

Provider Business Mailing Address
First Line	:	6301 N OAK TRFY
Second Line	:	SUITE 203
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4705
Country	:	US
Telephone Number	:	816-454-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 N OAK TRFY
Second Line	:	SUITE 203
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4705
Country	:	US
Telephone Number	:	816-454-3336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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