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General NPI Number Information
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NPI Number | 1407309909
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Entity Type | Organization
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Legal Business Name | JASON TUCKER DDS PLLC
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 08/01/2016
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Provider Practice Location Address
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Address Line | 2718 E 57TH AVE
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City | SPOKANE
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State | WA
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Zip | 99223-6605
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Country | US
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Telephone | 509-448-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 2718 E 57TH AVE
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City | SPOKANE
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State | WA
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Zip | 99223-6605
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Country | US
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Telephone | 509-448-5888
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JASON R TUCKER
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Credential | DDS
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Telephone | 509-448-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 60111978
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License Number State | WA
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