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General NPI Number Information
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NPI Number | 1336373679
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Entity Type | Individual
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Provider Name | TRENT TUCKER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 7325 FAR HILLS AVE
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City | DAYTON
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State | OH
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Zip | 45459-4415
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Country | US
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Telephone | 937-439-1606
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Fax |
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Provider Business Mailing Address
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Address Line | 8607 SEA PINES LN
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City | DAYTON
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State | OH
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Zip | 45458-3321
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Country | US
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Telephone | 419-680-0023
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30-024376
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License Number State | OH
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