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General NPI Number Information
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NPI Number | 1184748972
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Entity Type | Individual
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Provider Name | IVES HENRY TUCKER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7105 21ST AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-5850
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Country | US
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Telephone | 718-256-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WILLIAMSBURG CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3249
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Country | US
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Telephone | 732-238-7751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 037253-1
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License Number State | NY
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