Healthcare Provider Details

I. General information

NPI: 1134204324
Provider Name (Legal Business Name): AARON G. TUCKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 WEST 95TH STREET
OAK LAWN IL
60453
US

IV. Provider business mailing address

7625 W. 159TH STREET
TINLEY PARK IL
60477
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-5990
  • Fax: 708-423-8555
Mailing address:
  • Phone: 708-429-4770
  • Fax: 708-429-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019026965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: