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General NPI Number Information
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NPI Number | 1306320171
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Entity Type | Organization
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Legal Business Name | TRAVIS C TUCKER, DMD., INC.
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 1425 VICTOR AVE STE A
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City | REDDING
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State | CA
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Zip | 96003-4857
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Country | US
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Telephone | 717-660-6426
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Fax |
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Provider Business Mailing Address
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Address Line | 543 JEFFERSON ST
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City | REDLANDS
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State | CA
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Zip | 92374-3995
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Country | US
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Telephone | 717-660-6426
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRAVIS CRAIG TUCKER
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Credential | DMD
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Telephone | 717-660-6426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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